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The East African : Jun 21st 2015
The EastAfrican OUTLOOK JUNE 20-26,2015 S CI E N C E Post-partum contraceptive approved Ring could be made available in Kenya, Nige≥ia, Malawi, Zambia and Senegal By CHRISTABEL LIGAMI Special Correspondent T he World Health Organisation has approved a contraceptive for breastfeeding mothers in the post-partum period. Known as progesterone contra- ceptive vaginal ring (CVR) and developed by the Population Council, the ring provides women who breastfeed at least four times a day with a contraceptive option as early as four weeks after giving birth. This intravaginal ring can be used for up to a year. The inclusion of the progesterone CVR on the WHO’s essential medicines list will provide a new option to women to safely space their pregnancies. Each CVR can be used continu- ously for three months, and rings can be used successively for up to one year as long as the woman is breastfeeding. “In the first several months after childbirth, exclusive breastfeeding is an effective contraceptive option. But many women do not, or are unable, to exclusively breastfeed; and once a woman stops breastfeeding or begins supplementing her infant’s diet, or resumes menstruation, she is at risk of becoming pregnant,” said Saumya RamaRao, senior associate at the Population Council. “The progesterone CVR works by releasing a continuous low dose of the natural hormone progesterone, which reinforces the contraceptive effect of breastfeeding.” The ring made of a soft, flexible plastic is long-acting, and is completely under a woman’s control. Each ring can be used continuously for three months, and four rings A nursing mother. The WHO has approved a contraceptive ring for breastfeeding mothers. Picture: File can be used successively for up to one year. Where it is available, it is sold at a price equivalent to three months of progesterone-only-pills. Clinical trials have demonstrated that the ring is 98.5 per cent effective in preventing pregnancy when used correctly; is safe for mother and baby; and does not affect a woman’s ability to produce breast milk unlike oestrogen-containing oral contraceptives; can be inserted and removed by the mother herself; and allows fertility to return shortly after a woman stops using the ring. The ring does not require re- frigeration or special storage conditions, an advantage in countries that do not have a strong health system infrastructure. “More than 220 million women “Approval of the contraceptive is an important step in making the ring more available in the first post-partum year.” Saumya RamaRao, Population Council SAFETY The contraceptive is approved and being used in several Latin American countries. Clinical trials have demonstrated that the ring: • Is safe for both the mother and baby; • Does not affect a woman’s ability to produce breast milk; • Is 98.5 per cent effective if used correctly (for women who breastfeed at least four times a day); • Can be inserted and removed by the mother herself, reducing the need for involvement by skilled health care providers. in the developing world want to prevent pregnancy, but are not using modern contraception. Vaginal rings like the progesterone CVR represent an important advance in contraceptive development,” said Dr RamaRao. Breastfeeding women in sub-Sa- haran Africa who wish to delay another pregnancy have limited options for effective contraception. The WHO and Unicef recom- mend that women breastfeed exclusively for the first six months after birth and continue breastfeeding up to two years. But the percentage of women who breastfeed exclusively varies greatly by culture, economic context and time since giving birth. Health complications “Once a woman stops breast- feeding exclusively or resumes regular menstruation, she is at risk of pregnancy before she may be ready to have another child. Short intervals between births can put a mother, her baby, and his or her siblings at risk of health complications and death,” said Dr RamaRao. “Approval of the contraceptive is an important step in making the ring more widely available to the 70 per cent of women in the first post-partum year, who want to breastfeed for a long time and do not want to get pregnant.” The three-month progesterone CVR is approved for use in eight Latin American countries: Bolivia, Chile, Dominican Republic, Ecuador, El Salvador, Guatemala, Panama and Peru. Although not yet approved for use in other countries, efforts are underway to determine the feasibility and likely impact of introducing the ring in Kenya, Nigeria, Malawi, Zambia and Senegal, and results are expected soon from a clinical study required for registration of the progesterone CVR in India. Pa≥ents’ denial fuels childhood obesity epidemic By JAN HOFFMAN New York Times DESPITE WIDESPREAD publicity about the obesity epidemic, parents increasingly seem to be turning a blind eye as their children put on weight. In a recent study published in Childhood Obesity more than three-quarters of parents of preschool-age obese sons and nearly 70 per cent of parents of obese daughters described their children as “about the right weight.” The researchers also compared these 2012 survey results with those from a similar survey in 1994. Not only were the children in the recent survey significantly heavier, but the likelihood that parents could identify their child’s weight accurately had declined about 30 per cent. Dr David L. Katz, director of Yale’s Preven- tion Research Centre, has coined a word for the problem: “oblivobesity.” “Parents cannot ignore the threat of obesity to our children and still hope to fix it,” he wrote in an editorial accompanying the new study. One reason parents may have difficulty per- ceiving their child’s weight is because of the “new normal”: Throughout the developed world and even in some developing countries, children are generally becoming heavier. But in an interview, Katz also cited parents for “wilful, genuine denial.” Once a parent acknowledges the child has a problem, he said, “you have to deal with it.” Food police “‘Do I become the food police? Do I have to change my diet and walk the walk?’” he added. “So, often, it’s easier to pretend the problem’s not there.” Other experts counter that the problem can be complicated and subtle, the result of family dynamics. Perhaps the parents are resigned to being overweight. Perhaps there are slender siblings, and the parents cannot figure out a diet that fits all. “Denial can be a coping mechanism,” said Ar- naldo Perez, a doctoral candidate at the University of Alberta who researches what motivates families to seek help for their overweight children. Before judging them outright, providers should explore parents’ possible feelings of guilt and failure, he said. Denial may also be a form of wishful think- ing. It is “natural for a parent to want to think optimistically about their child,” Dr Thomas N. Robinson, a professor of paediatrics and director of the Centre for Healthy Weight at Stanford and Lucile Packard Children’s Hospital Stanford, wrote in an e-mail. “I have parents tell me that they waited to address it because they thought their child would ‘grow out’ of their extra weight,” he added. A child’s weight problem may escape notice for any number of reasons. Many clothing styles obscure shape, for instance, particularly for boys. “When they take their loose fitting shirts and pants off in the exam room, you see just how a tremendous amount of body fat can be hidden,” Robinson said. And when parents believe their children are active, they are more likely to consider their child’s weight to be normal, studies have shown. BRIEFS Cervical cancer not just a young woman’s killer Half of cervical cancer deaths occur in women over 65 and not as much in young women as perceived, a British Medical Journal report says. It argues that the age limit for cervical screening should be raised to 70, and older women should be targeted in health campaigns. While cervical cancer is the most common cancer in women under 35, it continues to affect women of all ages. The report found that women who had been tested regularly between the ages of 50 and 64 had “a relatively low risk” of getting the disease in the next 20 years. Imaging technology to guide brain surgeons Johns Hopkins researchers have developed an imaging technology that could provide surgeons with a colour-coded map of a patient’s brain showing which areas are cancerous. First developed in the early 1990s for imaging the retina, optical coherence tomography (OCT) operates on the same echolocation principle used by bats and ultrasound scanners, but it uses light rather than sound waves, yielding a higher-resolution image than does ultrasound. One unique feature of OCT is that, unlike x-ray and other scans, it delivers no ionising radiation to patients. 7 A chocolate a day keeps heart diseases at bay Eating up to 100g of chocolate every day is linked to lowered heart disease and stroke risk, according to research published online in the journal Heart. There seems to be no evidence for cutting out chocolate to lower the risk of cardiovascular disease, the researchers say. Higher chocolate intake was linked to an 11 per cent lower risk of cardiovascular disease; 25 per cent lower risk of associated death; and 9 per cent lower risk of hospital admission or death as a result of coronary heart disease, after taking dietary factors into account. Freezing embryos doesn’t improve IVF outcomes Results of a study performed at the Instituto Valenciano de Infertilidad (IVI) clinic in Valencia, Spain, has found no evidence that routinely freezing all embryos and delaying transfer to a subsequent cycle improves in vitro fertilisation (IVF) outcome in terms of ongoing pregnancy or live birth rates in women with a normal response to ovarian stimulation as previously reported. But the study found evidence that a freeze-all approach lowers the small risk of ovarian hyperstimulation syndrome (OHSS) in IVF, which is increased following conception.
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