Family Planning

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Recently, the World Health Organisation (WHO) and the United States Centre for Diseases Control and Prevention (CDC) reported that more than 140,000 people worldwide died from measles in 2018.

These deaths occurred as measles cases surged globally, amidst devastating outbreaks in all regions. Most deaths were among children under five years of age. Babies and very young children are at greatest risk of measles infections, with potential complications including pneumonia and encephalitis, a swelling of the brain, as well as lifelong disability, permanent brain damage and blindness or hearing loss.

Recently published evidence shows that contracting the measles virus can have further long-term health impacts, with the virus damaging the immune system’s memory for months or even years, following infection. This ‘immune amnesia’ leaves survivors vulnerable to other potentially deadly diseases, like influenza or severe diarrhoea, by harming the body’s immune defences. 

To prevent their children from succumbing to the infection, Dr. Motunrayo Bukola from Lagos University Teaching Hopital (LUTH), said parents should ensure vaccination of their children from age zero to five years. Spread of measles infection to other children usually occurs before diagnosis is made in the affected child.
She said: “This is because spread of the infection occurs at the early stage, when specific symptoms like the rash have not developed. So, immunisation is key to preventing acquisition and spread of measles virus infection.

“Usually, treatment is supportive. Antipyretic like acetaminophen for fever is administered. Oral vitamin A is also given. For those with complications, which are usually the cause of death, treatment is as required. Antibiotics should be given for pneumonia, a common complication, while oral salt solution is administered for diarrhoea.”

She explained that diagnosis is mostly clinical, as fever, purulent red eyes, cough, coryza; redness with white particles called koplik spot is seen in the mouth.

“This is specific in measles, but may not be seen in some cases, depending on the individual. Then a pattern rash occurs. The rash from measles starts from the hairline and spread downward to the face, neck, trunk and the limbs,” she explained. “In the case of outbreaks or non- specific symptoms, laboratory diagnosis can be made. This is a serological test with identification of measles specific IgM, immunoglobulin M or IgG.

“Measles affects both sexes. It is commoner in children below five years. The child has to be assessed by a doctor, who will examine for likely complications and treat accordingly. Such a child should be isolated, which means he/she should not go to school and other gatherings, where children are. Oftentimes, children have uncomplicated measles without parental knowledge that it was measles. This also occurs in schools and different crèches. So, schools should routinely evaluate the immunisation status of the students, by checking the immunisation cards. Booster doses should also be taken.”

Former President Association of Resident Doctors in LUTH Dr. Olubunmi Omojowolo, said immunisation with measles vaccine must balance the chance of zero conversion with the risk of infection. He said: “This is why in countries with endemic measles, the first dose of measles containing vaccine (MCV) is given as early as nine months, often complemented by another dose during the second year of life. 

Experience and modelling have shown that two doses of measles vaccine are required to interrupt indigenous transmission and achieve hard immunity. A single dose in the second year of life will induce immunity in about 95 per cent of immunised people.

“This means that 100 per cent uptake would be required in order to achieve the desired 95 per cent immunity level. However, about 95 per cent of those who fail to respond to a first dose develop immunity from a second dose and hence the benefit of a second dose. In Nigeria, today, immunisation programmes promote two or more dose measles immunisation schedule, with the first dose given during the second year of life and the second dose at an older age that differs between countries.

“Measles vaccine is most commonly administered as part of a combination of live attenuated vaccines that includes measles, mumps, rubella or measles, rubella and varicella (MMR or MMRV). Combination vaccines have been shown to elicit the same immune response as individual vaccines.

“Vaccinating individuals who are already immune to one or more of the antigens in the combination vaccine, either from previous immunisation or natural infection, are not associated with any increased risk of adverse events.”

“Symptoms will appear about nine to 11 days after initial infection. There is often a fever, which can range from mild to severe, up to 40.6 degrees centigrade. It can last several days, and it may fall and then rise again, when the rash appears.

“The reddish-brown rash appears around three to four days after initial symptoms. This can last for over a week. The rash usually starts behind the ears and spreads over the head and neck. After a couple of days, it spreads to the rest of the body, including the legs. As the spots grow, they often join together.”

“I used to be a full-time patient at this facility,” says Michelle Eze, a drug abuse survivor, as she signs her name in the register for a check-up with her psychiatrist at Karu General Hospital in Abuja, Nigeria’s Federal Capital Territory(FCT).

“I’m so glad I sought help in time as I was dependent on drugs and it cost me so much. It negatively affected the relationship with my family and people around me. I was disowned and left to face this harsh world all by myself. Drug abuse is a problem we should all join hands and fight it.”

Michelle is now a full-time ambassador against drug abuse among women.

One out of every four people who uses drugs in Nigeria is a woman, according to a 2018 report by the United Nations Office on Drugs and Crime (UNODC).

Over 300,000 Nigerians are high-risk drug users

Approximately 376 000 people – or about 0.4% of the Nigerian population aged 15-64 – are reckoned to be high-risk drug users, according to the UNODC report. Nearly 90% of these users regularly take opioids – particularly pharmaceutical opioids such as tramadol codeine, or morphine – while the others take cocaine or amphetamines.

Over 20% of the high-risk drug users inject drugs, with women first injecting on average at 20 years old and men first injecting on average at around 21 years old. HIV prevalence among women who inject drugs is almost seven times higher than among men who inject, according to the 2010 National Agency for the Control of AIDS (NACA) Integrated Biological and Behavioural Surveillance survey.

“At Karu hospital, we receive roughly 15 patients every day and usually at least half of them report to be using one drug or another,” says Pius Wabass, a psychiatric nurse on the Karu General Hospital’s psychiatry ward.

“These patients are often so young – under 40 – and, of late, more women are checking into our facility. The misuse of drugs

has serious health repercussions. Medically, opioids are primarily used for pain relief, including anaesthesia, while amphetamines are powerful stimulators of the central nervous system used to treat some medical conditions.”

Efforts to respond to drug use in Nigeria

As countries including Nigeria make efforts to respond to drug use among the population, health experts note that there are some factors that affect women more than men. A lot of factors have been identified as putting women at increased risk, some are psychological, cultural, social and economic aspects of their lives. Another issue is the general perception that drug use is a male issue and women users are often reluctant to seek help. The Federal Ministry of Health (FMOH) is now addressing this.

“The FMoH has taken up this challenge and currently working with all stakeholders to respond to drug use among young people, especially women,” explains Dr Jimoh Salaudeen from the Food and Drug Division, FMOH. As part of the response, a women-specific drug treatment programme has been established at the federal neuropsychiatric hospital in Kware in Sokoto State and the ministry hopes to replicate such centres across the country.”

Dr Salaudeen continues: “There is a strong linkage between opioid use disorders and health conditions such as preterm births, stillbirths, poor foetal growth, maternal death and neonatal abstinence syndrome. This is why the Ministry of Health has prioritized sexual reproductive health, particularly for women, within the context of drug treatment and harm reduction.”

Working assiduously to reduce drug demand and harm in Nigeria

The FMOH, with the support of WHO, established the National Technical Working Group (NTWG) on drug demand and harm reduction in Nigeria in May 2019.

“The NTWG is working under the leadership of the Minister of Health and is actively engaged in implementing a comprehensive public health response to the challenge of drug use in the country,” says Dr Rex Mpazanje, WHO Cluster Coordinator for Communicable and Non Communicable Diseases.Close

“This effort also includes bringing together different stakeholders at the national and state level for a concerted response. This includes advocacy, capacity building and resource mobilization to ensure promotion of evidence-based prevention activities and the availability of drug treatment and harm reduction programmes at community level.”

Target 3.5 of the United Nations 2030 Sustainable Development Goals (SDGs) is to strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. WHO Nigeria will continue to support to the Government of Nigeria in achieving this goal.

The behavioural medicine unit of the Karu General Hospital, Abuja. Many drug abuse patients are treated here.

Experts have emphasised on the need for Nigerians to embrace family planning fully as part of measures to curb maternal and infant mortality in the country.

They lamented that despite the drop in the fertility rate from 5.5 percent in 2013 to 5.3 percent in 2018, according to the Nigeria Demographic Health Survey (NDHS), with a two-percent increase in the total contraceptive prevalence rate (CPR) from 15 percent to 17 percent, the acceptance rate of family planning in some communities still remain low due to several barriers such as religion, culture and fear of the unknown among others. The implications, they said, remain multiple pregnancies and births, population explosion that puts pressure of the nation resources, as well as unsafe abortions, which increases the risk of maternal and infant mortality in Nigeria.

Speaking at a two-day media workshop on sexual reproductive health and rights, organised by Marie Stopes International Organisation Nigeria (MSION) in Ibadan, Oyo Sate, the Director Programme Operation, Emmanuel Ajah lamented that religion, sociocultural inhibitions and stigma, especially in rural communities, are discouraging women to demand for reproductive health care services. He said these pose great danger to the women and the society, as maternal mortality would be very high, especially with the belief held against birth control and population explosion regarded as a blessing by the communities.

Ajah said most of the women, in a bid to reduce childbearing, eventually engage in unsafe abortion, which end up costing their lives, as they fail to embrace contraceptive/family-planning commodities. “Unsafe abortions is the third leading cause of maternal deaths in Nigeria, and an overwhelming health problem in the country, yet it has not generated enough policy attention. Women who die from unsafe abortion are all pregnancy related, as millions of women have unmet need for family planning

“Other reasons for seeking abortion are too many frequent pregnancies, lack of awareness on fertility management, contraception failure, lack of access to quality family planning information and/or services,” he said.

Also speaking, the Head, Marketing and Strategic Communication, Ogechi Onuoha said Nigeria as country is very complex with different religious and ethnic backgrounds, which require massive awareness and sensitisation movement in certain states that are yet to accept family planning as a means of reducing maternal mortality. She said all stakeholders including the government must work together to address the socio-cultural norms such as, religious tenets, and women’s lack of decision-making power related to sexual and reproductive health to improve maternal survival in the country.

Onuoha said there must also be improvement in the family planning programmes in communities, as well as the availability of and access to services and commodities to slow the rate of population growth, which would put the country on a path to a healthier future for women and families.

“The focus is on dispelling myths and misconceptions about family planning, expanding the provision of family planning services and supplies to the last mile, and enabling an environment in which women and girls make informed choices on their health,” she added.

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The Federal Ministry of Health has said that if implemented properly, family planning can reduce maternal deaths by 30 per cent.

The Director, Reproductive Health Division at the ministry, Dr Kayode Afolabi, said this during a dialogue organised by the Development Research and Project Centre in collaboration with the ministry and other civil society organisations.

Afolabi noted that at the rate of 576 per 100,000 live births, maternal mortality in Nigeria was higher than the global average.

He said, “If we implement family planning fully and it is directed to all women who deserve it within a particular age group, it could prevent as high as 30 per cent of preventable maternal deaths. And it is also confirmed that at least 25 per cent of under-five mortalities can be prevented by contraceptives and childbirth spacing.”

Afolabi said that improved funding for family planning is critical to ensuring its success in the country.

He said the Federal Government was working hard to ensure access to family planning services in the country, adding that only 3,000 Primary Healthcare Centres offered family planning services four years ago, but more than 12, 000 centres now do so.

The director said other emerging issues in the uptake of family planning services in the country would be factored into the review of the policy.

He said the minister this year made a pledge of $4m to family planning and had promised that the government would pay it in full.

The director said the country had not been fulfilling most of its pledges, adding that although it recently pledged $3m for the basket funding for family planning yearly for four years, it had not redeemed this pledge.

“This was meant to total to $12m. Unfortunately, the fund released was only $7m in total,” he said.

While making his presentation, a member of the panel, Adedeji Aderibigbe, from the University of Ilorin, lamented the low level of advocacy on family planning in Nigeria.

“I realised that some of the documents reviewed in spite of having lines on family planning issues have no mention of family planning advocacy,” Aderibigbe said.

Your choice of partner can affect your health in many ways, both positively and negatively. Anything from their exercise habits and working hours to their personality can have an impact on your well-being. We investigate the surprising ways that your significant other can affect your health.

Whether you are in a new relationship or a long-term one, newlyweds or celebrating your golden wedding anniversary, a same-sex couple or of the opposite sex, the time spent with your partner can influence your health outcomes.

Having a healthy relationship is not only rewarding, but it also significantly shapes our long-term health in a similar way to getting a good night’s sleep, eating healthfully, and not smoking. Studies have shown, time and time again, that people who are in satisfying relationships feel happier, have fewer problems with health, and live longer.

On the flip side, having unhealthy connections or a lack of social ties is linked to depression, cognitive decline, and an increased risk of premature death.

Here are some of the beneficial and detrimental effects that your relationship could have on your well-being.

Positive effects of a partner on health

Pain relief

woman in labor holding partner's hand
A partner’s touch has been found to relieve pain in women.

It is well known that people subconsciously synchronize their footsteps when they walk together or mirror a friend’s posture during a conversation.

Investigators from the University of Colorado, Boulder and the University of Haifa in Israel have now discovered that when heterosexual lovers touch when the woman is in pain, couples’ heart rates and respiratory patterns synchronize and the woman’s pain dissipates.

These findings add to a growing body of evidence on “interpersonal synchronization,” a phenomenon in which people begin to physiologically mirror those that they spend time with. “The more empathic the partner and the stronger the analgesic effect, the higher the synchronization between the two when they are touching,” explains lead author Pavel Goldstein, a postdoctoral pain researcher at the University of Colorado, Boulder.

Help achieve healthy goals

Two heads are better than one when it comes to taking up healthy habits. Funded by Cancer Research UK, the British Heart Foundation, and the National Institute on Aging, scientists at University College London (UCL) in the United Kingdom revealed that if you want to swap bad habits for good, then you would be more successful if your partner also makes those changes.

Among women who smoked, the researchers found that 50 percent succeeded in quitting smokingif their partner gave up at the same time, compared with 17 percent whose partners were non-smokers already, and just 8 percent whose partners smoked regularly.

“Unhealthy lifestyles are a leading cause of death from chronic disease worldwide,” says study author Prof. Jane Wardle, director of Cancer Research UK’s Health Behaviour Research Centre at UCL. “The key lifestyle risks are smoking, excess weight, physical inactivity, poor diet, and alcohol consumption. Swapping bad habits for good ones can reduce the risk of disease, including cancer.”

Improve fitness

Echoing these findings, the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, conducted research finding that improving your fitness could also improve the fitness of your spouse.

Couples were asked about their physical activity levels at two medical visits conducted around 6 years apart. On the first visit, if a wife met the recommended guidelines for physical activity, her husband was 70 percent more likely to also reach those targets at subsequent visits than those whose wives were less active.

Conversely, when a husband met recommended activity levels, his wife was 40 percent more likely to also achieve these levels at follow-up visits.

When it comes to physical fitness, the best peer pressure to get moving could be coming from the person who sits across from you at the breakfast table,” says co-author Laura Cobb, a doctoral student at Johns Hopkins Bloomberg School of Public Health. “There’s an epidemic of people in this country who don’t get enough exercise, and we should harness the power of the couple to ensure people are getting a healthy amount of physical activity.”

Alter microbiome

man standing in the shower
Microbial exchange with your partner can occur simply from walking on the same bathroom floor.

Researchers from the University of Waterloo in Canada found that couples who live together influence the microbiome – that is, the community of bacteria and other microbes – on each other’s skin.

Commonalities between couples’ skin microbiome were strong enough that computer algorithms could detect couples that cohabit with an accuracy of 86 percent.

Skin regions that were the most similar between partners were on the couples’ feet. “In hindsight, it makes sense,” says Prof. Josh Neufeld, of the Faculty of Science in the Department of Biology at the University of Waterloo. “You shower and walk on the same floor barefoot. This process likely serves as a form of microbial exchange with your partner, and also with your home itself.”

Improve physical and mental health

While analyzing whether or not relationships are good for your health, David and John Gallacher, from Cardiff University in the U.K., confirmed that long-term, committed relationships are good for physical and psychological health, and that these benefits increase over time.

On average, individuals who are married live longer; women have better mental health when they are in committed relationships, while men have better physical health when in a committed relationship. The study authors say, “On balance it probably is worth making the effort.”

Decrease risk of health conditions

Studies have shown that partners can also affect each other’s risk and development of disease.

woman and man arguing
Persistent nagging from your partner could slow down diabetes progression.

For example, a study by Michigan State University (MSU) in East Lansing deduced that for men who are in an unhappy marriage, the development of diabetes is slower and treatment is more successful once they are diagnosed.

The researchers said that wives who continuously regulate their husband’s health behaviors and who are seen as annoying and provoking hostility and emotional distress in the husbands could explain this finding.

The study challenges the traditional assumption that negative marital quality is always detrimental to health,” says lead investigator Hui Liu, an associate professor of sociology at MSU. “It also encourages family scholars to distinguish different sources and types of marital quality. Sometimes, nagging is caring.”

Researchers from the University of Michigan have also determined that having an optimistic spouse predicted fewer chronic illnesses and better mobility over time.

A growing body of research shows that the people in our social networks can have a profound influence on our health and well-being,” says lead study author Eric Kim, a doctoral student in the University of Michigan’s Department of Psychology. “This is the first study to show that someone else’s optimism could be impacting your own health.”

In other research, people who are happily wed are more than three times as likely to be alive 15 years after coronary bypass surgery as their unmarried counterparts. Married people also are less likely to have cardiovascular problems than individuals who are single, divorced, or widowed.

Adverse effects of a partner on health

Intensify pain

In contrast to the research that showed a partner’s touch decreases pain, a study by King’s College London in the U.K. found that being in the company of your partner could make pain worse.

The researchers found that the more avoidant of closeness women were in their relationships, the more pain they experienced when given a laser pulse on their finger.

Research led by the University of Edinburgh in the U.K. also found a connection between partners and pain. The team found that partners of individuals with depression have an increased risk of experiencing chronic pain.

The researchers’ analysis showed that depression and chronic pain share common causes. Some of these causes are genetic while others stem from the environment shared by the partners.

Derail your diet

healthy eating plan
Dieting with your partner could end up derailing your weight loss plans.

Dieting with your partner may seem to be a good idea, but research has indicated that among romantic couples, the more successful one partner is at restricting their diet and eating more healthfully, the less confident the other partner becomes at controlling their food portions.

When people strive to reach a goal, being close (in this case, romantically) with someone who is successfully reaching the same goal can make the other partner less confident in their own efforts to reach the goal,” explains Jennifer Jill Harman, an associate professor at Colorado State University in Fort Collins.

Facilitate weight gain

Marriage has been positively correlated with weight gain among couples. For example, lead researcher Andrea L. Meltzer – an assistant professor at Southern Methodist University in Dallas, TX – and collaborators unveiled that newlyweds who are satisfied with their marriage are more likely to gain weight in the early years of marriage than those who are unsatisfied.

“On average, spouses who were more satisfied with their marriage were less likely to consider leaving their marriage, and they gained more weight over time,” states Prof. Meltzer. “In contrast, couples who were less satisfied in their relationship tended to gain less weight over time.

Other research by the University of Bath’s School of Management in the U.K. showed that marriage makes men gain weight and that fatherhood exacerbates the problem further.

Increase risk of health conditions

In contrast with research signalling that your significant other can decrease your risk of certain health conditions, other studies show the reverse.

For example, the McGill University Health Centre in Canada has suggested that if someone has type 2 diabetes, their partner has a 26 percent increased risk of also developing the condition.

While spouses are not related biologically, they share the same environment, social habits, and eating and exercising patterns – all of which are factors that alter the risk of developing type 2 diabetes.

“When we talk about family history of type 2 diabetes, we generally assume that the risk increase that clusters in families results from genetic factors. What our analyses demonstrate is that risk is shared by spouses,” says senior study author Kaberi Dasgupta, of the Research Institute at McGill University.

a couple sitting on the bed ignoring each other
Giving your spouse the silent treatment increases your risk of back pain and stiff muscles.

Furthermore, the way that you react to disagreements and argue with your partner could predict health problems later in life. The University of California, Berkeley, and Northwestern University in Evanston, IL, revealed that fits of rage during marital spats can predict cardiovascular problems, and shutting down and giving the silent treatment raises the risk of a bad back or stiff muscles.

“Conflict happens in every marriage, but people deal with it in different ways. Some of us explode with anger; some of us shut down,” says lead study author Claudia Haase, an assistant professor of human development and social policy at Northwestern University. “Our study shows that these different emotional behaviours can predict the development of different health problems in the long run.”

Research has also indicated that individuals may unintentionally worsen their partner’s insomnia. Moreover, other research found that inflammation markers rise in tired partners who argue.

Additionally, in older adults, researchers learned that the frailer an individual – a condition that affects around 10 percent of those aged 65 and over – the more likely it is that they will become depressed. Equally, the more depressed an older person is, the frailer they will become.

What is more, people married to frail spouses had an increased risk of becoming frail themselves, and those married to a depressed partner were also more likely to become depressed.

And interestingly, health changes influenced by a romantic partner do not necessarily end when they pass away.

Kyle Bourassa, a psychology doctoral student at the University of Arizona in Tucson, and colleagues found that couples’ qualities of life are linked even when one partner dies.

The people we care about continue to influence our quality of life even when they are gone. We found that a person’s quality of life is as interwoven with and dependent on their deceased spouse’s earlier quality of life as it is with a person they may see every day.

Kyle Bourassa

Bourassa says that even though we have lost the people we love, they remain with us. The research highlights how important relationships are for our health and well-being. However, he does say that the findings are cut both ways. “If a participant’s quality of life was low prior to his or her death, then this could take a negative toll on the partner’s later quality of life as well.”