Tropical Doctor, October 1992
173
in the district. Official family planning services in the district are scanty and concentrated in the few urban centres. The total population in Kabarole district is 741 000 people, growing at a rate of 3.30/0 (National census 1991). Ninety-five percent of these people live in rural areas. Literacy rate in the district is about 40% for adult females. Sampling for the survey was done as follows: nine out of 34 peripheral health facilities were randomly selected; for each health facility two villages (each with 300-700 people) were selected, taking the nearest and the most far (at least 8 km away). In each village a list of households was compiled, eight households selected using systematic random sampling, and all women aged 15-49 years (n = 198) interviewed about their fertility preferences, knowledge, and practices regarding family planning. Eighteen per cent of respondents were aged below 20 years while 80% fell in the range 20-44 years. One fifth of women were single, three-quarters were in marital union (married or living together) and the rest were divorced or widowed. Forty-five per cent of the single respondents were below the age of 20. Average age for women at first entry into a marital union was 16.7 years. Thirty-seven per cent of all respondents had no formal education, 50% had some primary education, and 13% had attended secondary school. Most (75%) of the people were peasant farmers and traders (14%). The average number of living children per respondent was three, ranging from one for the age group 15-19, to seven children for those 45-49 years. Several (17%) said they would produce as many children as God decides for them. The most frequent ideal number of children for the remaining respondents was six. Most (67%) respondents were in need of family planning: ie they either did not want to produce any more children or preferred to wait over 2 years before their next child. None,
however, was using any contraceptive. Of all respondents, 73% could list one or more methods of contraception, 17% had ever used modern contraceptives (Table 1), and only 48% knew a source of family plannnng services. Current use of modern contraceptive methods is still low (4%). Although 71% of women believed that family planning can lead to improved maternal and child health, misconceptions about side effects of modern contraceptives were widespread. Of the 145 women who knew a contraceptive method, fears of side effects were: none (30%), do not know (27%), prolonged or irregular menses (21%), deformed babies (16%), abdominal pain (8%), weight gain (8%), infertility (7%), headaches (5%), hypertension (5%) and promiscuity (4%). The above results are similar to those obtained for the western region during a demographic and health survey in 1988/89. Of those women who knew a contraceptive method, 28% reported their sexual partner's acceptance of contraceptive use, 44% reported opposition, while 28% did not know their partners' attitudes and 7% had no sexual partners. However, only one third of women whose partners accepted family planning had ever used modern contraceptives. Lack of adequate information and low accessibility of family planning services must be addressed. We suggest that men must be involved in family planning, and programmes must include efforts to reach them. To minimize misconceptions about the pill requires an effective information campaign, emphasizing the low risks and the health benefits of oral contraceptives.
Table 1. Percentage distribution of 198 women by contraceptive method known, and ever used
Attitudes to hearing aid use in Nigerian patients A study of the attitude of hearing impaired Nigerians to the use of hearing aids was conducted over a 5-year period between 1984 and 1989 at the General Hospital, Owerri. Of the 201 patients who needed a hearing aid, only 40 (20%) agreed to use one (28 women and 12 men). Of these, the majority (21) accepted a behind-the-ear aid. Various factors affected the acceptance and rejection of hearing aids. Eighty per cent (161)of those who needed to use hearing aids rejected them outright. The rejectors fell within the age group of 20-45 years while the acceptors were mainly below 20 years and above 45 years of age. The reasons for rejection included psychological, socio-cultural and financial factors. Some rejectors thought the aids to be cumbersome 'foreign bodies'; others feared embarrassment and ridicule when the stigma of their disability was revealed in public. The prohibitive cost of aids was a significant cause for non-acceptance. In 1989 in Nigeria an in-the-ear aid cost about W5000 (about $500); a behind-the-ear aid cost W2000-W3000
Know method (%)
Ever used
Contraceptive method Any method Any modern method Pill Condom Injection Female sterilization Male sterilization Diaphragm/foam/jelly IUD Any traditional method Periodic abstinence Prolonged breastfeeding Withdrawal Herbs Others
73.2 69.7 58.1 11.6 4.5 16.7 0.0 0.0 0.0 21.2 7.6 10.6 1.0 7.1 1.5
18.2 16.7 15.7 0.0 3.0 0.0 0.0 0.0 0.0 6.1 4.5 2.5 0.0 1.0 0.5
(%)
W KIPP
E M
KWERED
B K SSEMPEBWA
Deutsche Gesellschaft fuer Technische Zusammenarbeit (GTZ), Fort Portal, Uganda Ministry of Health, Fort Portal Uganda
174
Tropical Doctor, October 1992
($200-$350), while a body-worn aid cost ~ 1000- ~ 1500 (about $100-$150). Some patients stated that the background noise effect contributed to their refusal to use hearing aids, while some rejected aids in the belief that drugs would improve their hearing. These few wandered from hospital to hospital in the futile effort to seek a cure. It seems likely that lack of supportive services (eg hearing centres where moulds can be easily made or replaced), the non-existence of hearing therapists and the scarcity of audiometricians and ENT specialists added to the failure of some patients to accept the use of hearing aids. The few available ENT units in the country are in the big cities which are far from the rural communities. The frustrations of long distance travel in search of help, and sometimes the fruitless search for batteries for their aids, compel some of the patients to throwaway their aids. The paramount and compelling reason for acceptance of a hearing aid was the need to communicate properly. Women made up the majority of acceptors, despite the fact that they did not constitute the majority of patients with hearing impairment in the study area. (A previous study by the author revealed equal incidence in both sexes-.) Perhaps the predominance of women is attributable to their need to communicate with the family in the daily running of the home. Students in institutions of learning, chief executives of companies, elders in the village and heads of families tended to accept hearing aids willingly. The use of hearing aids as a means of audiological rehabilitation is still new in most developing countries. Stephens- stated that the hearing aid comprises the most important single component of the process of audiological rehabilitation. Kyle et al,' observed that the process of adjustment to the use of a hearing aid is determined by a whole series of personal and situational factors. Our study has shown that the great majority of people who could benefit from a hearing aid refuse to use one. We need to implement health education at the primary health care level on the potential benefits of hearing aids. We would like to see the development of a hearing aids policy for Nigeria, to be included in the National health care programme. Hearing aids should be made easily available and readily affordable in the health facilities both of government and of voluntary agencies. A B
CHUKUEZI
Department of ENT General Hospital, Owerri, Imo State, Nigeria
REFERENCES
1 Chukuezi AB. Profound and total hearing loss in Owerri, Nigeria. E Afr J Med 1991 2 Stephens SD. Hearing aid selection; an integrated approach. Br J AudioI1984;18:199-210 3 Kyle JG, Wood PL. Changing patterns of hearing aid use and level of support. Br J Audiol 1984;18:211-16
A simple method for measuring nasal patency in children Nasal obstruction and mouth breathing are of common occurrence in children. To measure the patency of nasal passage in children is a difficult proposition as the child may not co-operate with the use of elaborate equipment. The ideal technique should be simple and should not interfere with the normal anatomy and physiology of the nose. It is also important that it meets the criteria for clinical applicability and reproducibility! and is comfortable for the patient. Though rhinomanometry has been in use for a long time, it requires special equipment which may not be available at most centres in developing countries. We have been successfully using a simple and accurate device in our everyday practice. This consists of a laminated graph paper. To make it attractive for the child, the reverse side of the graph is pasted with a familiar comic figure. The child is allowed to play with it before use to make him familiar and remove unwanted fear. This is then cooled and held beneath the child's nostrils. The child is asked to breathe gently. The fogging produced on the surface is outlined and the number of squares counted. Thus we can compare both sides and the preand postoperative status of nasal obstruction. This is a simple objective method that is very convenient, reproducible and involves little expense. Humidity and temperature do not affect the results. Even the cooling may be dispensed with in temperate climates and in the winter season in the tropics. It can be used with ease, instead of the more expensive rhinomanometry and with almost no compromise on accuracy. I
SINGH
G GATHWALA
SP S
YADAV
2
1
Departments of 'Otolaryngology and 2Pediatrics Medical College and Hospital, Rohtak, India
REFERENCE
1 Gartner R, Podoshin L, Fradis M. A simple method of measuring the nasal airway in clinical work. J Laryngol Otol 1984;98:351-5 Correspondence to Dr Ishwar Singh, 802/22 Opp NFL Area Office, Jhang Colony, Rohtak-124001, India
Reduction in perinatal mortality I would like to add to Dr Larsen's comments regarding reduction in perinatal mortality (Tropical Doctor, April 1992, p 49), from the district hospital perspective. I have previously shown that many perinatal deaths in rural hospitals may be due to simple errors or omissions in care'. Essentially, I found that about a third of all perinatal deaths were so caused in one rural hospital and its clinics, and that rapid intervention eliminated such deaths. Intervention included protocols of care and inservice training as advocated by Dr Larsen. Perinatal mortality fell from 60/1000 to 40/1000. Analysis of perinatal mortality for 12 months at another rural hospital and its clinics shows that 19l1fo of all perinatal deaths were
173
in the district. Official family planning services in the district are scanty and concentrated in the few urban centres. The total population in Kabarole district is 741 000 people, growing at a rate of 3.30/0 (National census 1991). Ninety-five percent of these people live in rural areas. Literacy rate in the district is about 40% for adult females. Sampling for the survey was done as follows: nine out of 34 peripheral health facilities were randomly selected; for each health facility two villages (each with 300-700 people) were selected, taking the nearest and the most far (at least 8 km away). In each village a list of households was compiled, eight households selected using systematic random sampling, and all women aged 15-49 years (n = 198) interviewed about their fertility preferences, knowledge, and practices regarding family planning. Eighteen per cent of respondents were aged below 20 years while 80% fell in the range 20-44 years. One fifth of women were single, three-quarters were in marital union (married or living together) and the rest were divorced or widowed. Forty-five per cent of the single respondents were below the age of 20. Average age for women at first entry into a marital union was 16.7 years. Thirty-seven per cent of all respondents had no formal education, 50% had some primary education, and 13% had attended secondary school. Most (75%) of the people were peasant farmers and traders (14%). The average number of living children per respondent was three, ranging from one for the age group 15-19, to seven children for those 45-49 years. Several (17%) said they would produce as many children as God decides for them. The most frequent ideal number of children for the remaining respondents was six. Most (67%) respondents were in need of family planning: ie they either did not want to produce any more children or preferred to wait over 2 years before their next child. None,
however, was using any contraceptive. Of all respondents, 73% could list one or more methods of contraception, 17% had ever used modern contraceptives (Table 1), and only 48% knew a source of family plannnng services. Current use of modern contraceptive methods is still low (4%). Although 71% of women believed that family planning can lead to improved maternal and child health, misconceptions about side effects of modern contraceptives were widespread. Of the 145 women who knew a contraceptive method, fears of side effects were: none (30%), do not know (27%), prolonged or irregular menses (21%), deformed babies (16%), abdominal pain (8%), weight gain (8%), infertility (7%), headaches (5%), hypertension (5%) and promiscuity (4%). The above results are similar to those obtained for the western region during a demographic and health survey in 1988/89. Of those women who knew a contraceptive method, 28% reported their sexual partner's acceptance of contraceptive use, 44% reported opposition, while 28% did not know their partners' attitudes and 7% had no sexual partners. However, only one third of women whose partners accepted family planning had ever used modern contraceptives. Lack of adequate information and low accessibility of family planning services must be addressed. We suggest that men must be involved in family planning, and programmes must include efforts to reach them. To minimize misconceptions about the pill requires an effective information campaign, emphasizing the low risks and the health benefits of oral contraceptives.
Table 1. Percentage distribution of 198 women by contraceptive method known, and ever used
Attitudes to hearing aid use in Nigerian patients A study of the attitude of hearing impaired Nigerians to the use of hearing aids was conducted over a 5-year period between 1984 and 1989 at the General Hospital, Owerri. Of the 201 patients who needed a hearing aid, only 40 (20%) agreed to use one (28 women and 12 men). Of these, the majority (21) accepted a behind-the-ear aid. Various factors affected the acceptance and rejection of hearing aids. Eighty per cent (161)of those who needed to use hearing aids rejected them outright. The rejectors fell within the age group of 20-45 years while the acceptors were mainly below 20 years and above 45 years of age. The reasons for rejection included psychological, socio-cultural and financial factors. Some rejectors thought the aids to be cumbersome 'foreign bodies'; others feared embarrassment and ridicule when the stigma of their disability was revealed in public. The prohibitive cost of aids was a significant cause for non-acceptance. In 1989 in Nigeria an in-the-ear aid cost about W5000 (about $500); a behind-the-ear aid cost W2000-W3000
Know method (%)
Ever used
Contraceptive method Any method Any modern method Pill Condom Injection Female sterilization Male sterilization Diaphragm/foam/jelly IUD Any traditional method Periodic abstinence Prolonged breastfeeding Withdrawal Herbs Others
73.2 69.7 58.1 11.6 4.5 16.7 0.0 0.0 0.0 21.2 7.6 10.6 1.0 7.1 1.5
18.2 16.7 15.7 0.0 3.0 0.0 0.0 0.0 0.0 6.1 4.5 2.5 0.0 1.0 0.5
(%)
W KIPP
E M
KWERED
B K SSEMPEBWA
Deutsche Gesellschaft fuer Technische Zusammenarbeit (GTZ), Fort Portal, Uganda Ministry of Health, Fort Portal Uganda
174
Tropical Doctor, October 1992
($200-$350), while a body-worn aid cost ~ 1000- ~ 1500 (about $100-$150). Some patients stated that the background noise effect contributed to their refusal to use hearing aids, while some rejected aids in the belief that drugs would improve their hearing. These few wandered from hospital to hospital in the futile effort to seek a cure. It seems likely that lack of supportive services (eg hearing centres where moulds can be easily made or replaced), the non-existence of hearing therapists and the scarcity of audiometricians and ENT specialists added to the failure of some patients to accept the use of hearing aids. The few available ENT units in the country are in the big cities which are far from the rural communities. The frustrations of long distance travel in search of help, and sometimes the fruitless search for batteries for their aids, compel some of the patients to throwaway their aids. The paramount and compelling reason for acceptance of a hearing aid was the need to communicate properly. Women made up the majority of acceptors, despite the fact that they did not constitute the majority of patients with hearing impairment in the study area. (A previous study by the author revealed equal incidence in both sexes-.) Perhaps the predominance of women is attributable to their need to communicate with the family in the daily running of the home. Students in institutions of learning, chief executives of companies, elders in the village and heads of families tended to accept hearing aids willingly. The use of hearing aids as a means of audiological rehabilitation is still new in most developing countries. Stephens- stated that the hearing aid comprises the most important single component of the process of audiological rehabilitation. Kyle et al,' observed that the process of adjustment to the use of a hearing aid is determined by a whole series of personal and situational factors. Our study has shown that the great majority of people who could benefit from a hearing aid refuse to use one. We need to implement health education at the primary health care level on the potential benefits of hearing aids. We would like to see the development of a hearing aids policy for Nigeria, to be included in the National health care programme. Hearing aids should be made easily available and readily affordable in the health facilities both of government and of voluntary agencies. A B
CHUKUEZI
Department of ENT General Hospital, Owerri, Imo State, Nigeria
REFERENCES
1 Chukuezi AB. Profound and total hearing loss in Owerri, Nigeria. E Afr J Med 1991 2 Stephens SD. Hearing aid selection; an integrated approach. Br J AudioI1984;18:199-210 3 Kyle JG, Wood PL. Changing patterns of hearing aid use and level of support. Br J Audiol 1984;18:211-16
A simple method for measuring nasal patency in children Nasal obstruction and mouth breathing are of common occurrence in children. To measure the patency of nasal passage in children is a difficult proposition as the child may not co-operate with the use of elaborate equipment. The ideal technique should be simple and should not interfere with the normal anatomy and physiology of the nose. It is also important that it meets the criteria for clinical applicability and reproducibility! and is comfortable for the patient. Though rhinomanometry has been in use for a long time, it requires special equipment which may not be available at most centres in developing countries. We have been successfully using a simple and accurate device in our everyday practice. This consists of a laminated graph paper. To make it attractive for the child, the reverse side of the graph is pasted with a familiar comic figure. The child is allowed to play with it before use to make him familiar and remove unwanted fear. This is then cooled and held beneath the child's nostrils. The child is asked to breathe gently. The fogging produced on the surface is outlined and the number of squares counted. Thus we can compare both sides and the preand postoperative status of nasal obstruction. This is a simple objective method that is very convenient, reproducible and involves little expense. Humidity and temperature do not affect the results. Even the cooling may be dispensed with in temperate climates and in the winter season in the tropics. It can be used with ease, instead of the more expensive rhinomanometry and with almost no compromise on accuracy. I
SINGH
G GATHWALA
SP S
YADAV
2
1
Departments of 'Otolaryngology and 2Pediatrics Medical College and Hospital, Rohtak, India
REFERENCE
1 Gartner R, Podoshin L, Fradis M. A simple method of measuring the nasal airway in clinical work. J Laryngol Otol 1984;98:351-5 Correspondence to Dr Ishwar Singh, 802/22 Opp NFL Area Office, Jhang Colony, Rohtak-124001, India
Reduction in perinatal mortality I would like to add to Dr Larsen's comments regarding reduction in perinatal mortality (Tropical Doctor, April 1992, p 49), from the district hospital perspective. I have previously shown that many perinatal deaths in rural hospitals may be due to simple errors or omissions in care'. Essentially, I found that about a third of all perinatal deaths were so caused in one rural hospital and its clinics, and that rapid intervention eliminated such deaths. Intervention included protocols of care and inservice training as advocated by Dr Larsen. Perinatal mortality fell from 60/1000 to 40/1000. Analysis of perinatal mortality for 12 months at another rural hospital and its clinics shows that 19l1fo of all perinatal deaths were
