Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight.

BACKGROUND: "Kangaroo mother care," a type of newborn care involving skin-to-skin contact with the mother or other caregiver, reduces mortality in infants with low birth weight (<2.0 kg) when initiated after stabilization, but the majority of deaths occur before stabilization. The safety and efficacy of kangaroo mother care initiated soon after birth among infants with low birth weight are uncertain. METHODS: We conducted a randomized, controlled trial in five hospitals in Ghana, India, Malawi, Nigeria, and Tanzania involving infants with a birth weight between 1.0 and 1.799 kg who were assigned to receive immediate kangaroo mother care (intervention) or conventional care in an incubator or a radiant warmer until their condition stabilized and kangaroo mother care thereafter (control). The primary outcomes were death in the neonatal period (the first 28 days of life) and in the first 72 hours of life. RESULTS: A total of 3211 infants and their mothers were randomly assigned to the intervention group (1609 infants with their mothers) or the control group (1602 infants with their mothers). The median daily duration of skin-to-skin contact in the neonatal intensive care unit was 16.9 hours (interquartile range, 13.0 to 19.7) in the intervention group and 1.5 hours (interquartile range, 0.3 to 3.3) in the control group. Neonatal death occurred in the first 28 days in 191 infants in the intervention group (12.0%) and in 249 infants in the control group (15.7%) (relative risk of death, 0.75; 95% confidence interval [CI], 0.64 to 0.89; P = 0.001); neonatal death in the first 72 hours of life occurred in 74 infants in the intervention group (4.6%) and in 92 infants in the control group (5.8%) (relative risk of death, 0.77; 95% CI, 0.58 to 1.04; P = 0.09). The trial was stopped early on the recommendation of the data and safety monitoring board owing to the finding of reduced mortality among infants receiving immediate kangaroo mother care. CONCLUSIONS: Among infants with a birth weight between 1.0 and 1.799 kg, those who received immediate kangaroo mother care had lower mortality at 28 days than those who received conventional care with kangaroo mother care initiated after stabilization; the between-group difference favoring immediate kangaroo mother care at 72 hours was not significant. (Funded by the Bill and Melinda Gates Foundation; Australian New Zealand Clinical Trials Registry number, ACTRN12618001880235; Clinical Trials Registry-India number, CTRI/2018/08/015369.).

Maternal mortality in the last triennium of the Millennium Development Goal Era at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

The maternal mortality ratio (MMR) of Nigeria remains high. This retrospective study aims to suggest evidence-based strategies towards achieving the sustainable development goal target 3.1 at the Obafemi Awolowo University Teaching Hospital (OAUTHC), Nigeria by providing contemporary data on MMR between October 2012 and September 2015. There were 86 maternal deaths and 5243 live births over the triennium, with annual MMRs of 1744, 1622 and 1512/100,000 live births, respectively. Fifty-six (65.2%) were postpartum deaths, while 44 (51.2%) occurred within 12 hours of admission. Using the WHO ICD-10 system, the causes of mortality were pregnancy-related infections; 26 (30.2%), haemorrhage; 20 (23.3%), hypertension; 13 (15.2%) and pregnancies with abortive outcomes; 11 (12.7%). Financial constraints, misdiagnosis and delayed referrals constituted the predominant contributors. The MMR at OAUTHC, Nigeria in the last triennium of the MDG was 'Extremely High'. Improved aseptic techniques, blood transfusion services, antimicrobial sensitivity evaluation, Universal Health Coverage, training-retraining of skilled birth-attendants and effective referral systems are advocated. IMPACT STATEMENT What is already known on the subject of the paper: Nigeria now contributes the largest proportion (19%) of the burden of maternal mortality worldwide, despite constituting just 2% of the global population. Reversing this adverse trend during the sustainable development goal (SDG) period demands effective strategies, which can only be predicated on reliable data at the hospital, regional and national levels. WHAT THIS STUDY ADDS: This article provides the contemporary maternal mortality data of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, during the last triennium of the Millennium Development Goal era. The findings from the study revealed that the average maternal mortality ratio (MMR) of the Hospital over the three years was 1640/100,000 live births, and that pregnancy-related infection is now the leading cause of maternal death, followed by obstetric haemorrhage. What the implications are for clinical practice: Improvement in aseptic techniques, evaluation of antimicrobial sensitivity patterns and efficient blood transfusion services, as well as Universal Health Insurance coverage and Skilled Birth Attendants will improve the maternal health indices of the hospital, and ultimately the country during the SDG execution period.

Mpox in pregnancy: Management, risks and challenges in Africa and lessons from the COVID-19 pandemic.

Data on mpox in pregnancy are currently limited. Historically, only 65 cases in pregnancy have been reported globally since mpox was discovered in 1958. This includes 59 cases in the current outbreak. Vertical transmission was confirmed in one patient. Pregnant women are at high risk of severe disease owing to immunological and hormonal changes that increase susceptibility to infections in pregnancy. African women appear to be at higher risk of mpox infection and adverse outcomes in pregnancy for epidemiological and immunologic reasons, in addition to the background high rates of adverse feto-maternal outcomes in the region. This risk is potentially heightened during the COVID-19 pandemic due to the possibility of mpox virus exportation/importation as a result of the lifting of movement restrictions and trans-border travels between countries affected by the current outbreak. Furthermore, coinfection with mpox and COVID-19 in pregnancy is possible, and the clinical features of both conditions may overlap. Challenges of diagnosis and management of mpox in pregnancy in Africa include patients concealing their travel history from healthcare providers and absconding from/evading isolation after diagnosis, shortage of personal protective equipment and polymerase chain reaction testing facilities for diagnosis, vaccine hesitancy/resistance, and poor disease notification systems. There is a need for local, regional and global support to strengthen the capacity of African countries to address these challenges and potentially reduce the disease burden among pregnant women in the continent.

Stillbirths: why they matter.

In this first paper of The Lancet's Stillbirths Series we explore the present status of stillbirths in the world-from global health policy to a survey of community perceptions in 135 countries. Our findings highlight the need for a strong call for action. In times of global focus on motherhood, the mother's own aspiration of a liveborn baby is not recognised on the world's health agenda. Millions of deaths are not counted; stillbirths are not in the Global Burden of Disease, nor in disability-adjusted life-years lost, and they are not part of the UN Millennium Development Goals. The grief of mothers might be aggravated by social stigma, blame, and marginalisation in regions where most deaths occur. Most stillborn babies are disposed of without any recognition or ritual, such as naming, funeral rites, or the mother holding or dressing the baby. Beliefs in the mother's sins and evil spirits as causes of stillbirth are rife, and stillbirth is widely believed to be a natural selection of babies never meant to live. Stillbirth prevention is closely linked with prevention of maternal and neonatal deaths. Knowledge of causes and feasible solutions for prevention is key to health professionals' priorities, to which this Stillbirths Series paper aims to contribute.

Adjunctive rectal misoprostol versus oxytocin infusion for prevention of postpartum hemorrhage in women at risk: a randomized controlled trial.

AIM: The aim of this study was to evaluate the efficacy of adjunctive rectal misoprostol compared to oxytocin infusion in the prevention of primary postpartum hemorrhage after routine active management of the third stage of labor in women with identifiable risk factors for uterine atony. MATERIAL AND METHODS: A double-blind randomized controlled trial was carried out at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. A total of 264 parturients with known risk factors for postpartum hemorrhage were randomized to receive either rectal misoprostol (600 µg; n = 132) or oxytocin infusion (20 IU in 500 mL; n = 132) after routine active management of the third stage of labor. Intrapartum blood loss was measured using a combination of the BRASSS-V calibrated drapes and differential pad weighing. Hematocrit was measured intrapartum and 24 h postpartum. RESULTS: There was no significant difference (P = 0.07) in the mean intrapartum blood loss between the misoprostol (387.28 ± 203.09 mL) and oxytocin (386.73 ± 298.51 mL) groups. There was also no difference in the requirement for additional intervention for uterine atony (P = 0.74). Postpartum hematocrit drop and blood transfusion were, however, significantly less in the misoprostol group. CONCLUSION: Rectal misoprostol is as effective as oxytocin infusion as an adjunct for prevention of postpartum hemorrhage in women with risk factors for uterine atony and is associated with a lower hematocrit drop and blood transfusion postpartum. However, shivering, pyrexia and vomiting are more frequent with misoprostol, though usually self-limited.

Prospective cohort study of prevention of mother to child transmission of hepatitis B infection and 9 months follow-up of hepatitis B-exposed infants at Ile-Ife, Nigeria.

OBJECTIVES: Eliminating mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is central to WHO's target of reducing hepatitis B infection in children to <0.1% by 2030. While Nigeria accounts for 8.3% of the global burden, interventional studies on prevention of MTCT of HBV are hardly available. This study aimed to assess the impact of prevention of MTCT interventions on vertical transmission of HBV among pregnant women in Nigeria. DESIGN: A prospective cohort study. SETTING: A University Teaching Hospitals Complex in Nigeria between 2015 and 2021. PARTICIPANTS: 10 866 pregnant women and their pre-existing children. INTERVENTIONS: Eligible pregnant women were screened for HBsAg using chromatographic immunoassay (Micropoint, USA). HbsAg-positive women had HBV serological assay done and their pre-existing children were screened. Women with HBV DNA ≥2 00 000 IU/mL and those positive for hepatitis B e-antigen (HBeAg) had 300 mg/day of Tenofovir Disoproxil Fumarate (TDF) in the third trimester. The newborns had hepatitis B vaccines and HB immunoglobulin (HBIG) administered, followed by testing for HBsAg at 9 months postnatally. PRIMARY OUTCOME MEASURES: Prevalence of chronic hepatitis B infection in pregnancy, and the incidence of MTCT of HBV. RESULTS: Overall, 395 women had chronic HBV infection, giving a prevalence of 3.64%. Their mean age was 31.51±5.71 years, with a median parity of 1.2. Thirteen women (5.2%) were positive for HBeAg, seven (3.1%) of the 225 pre-existing hepatitis B-exposed children were HbsAg positive and 17 women had prenatal TDF. Overall, 376 women completed the study, with mean birth weight of 3.21±1.86 kg and perinatal mortality rate of 29.2/1000 births. Hepatitis Bvaccine-HBIG combination was administered to 260 newborns, while the others had hepatitis B vaccine alone. All the children tested negative to the HbsAg at 9 months. CONCLUSION: Eliminating MTCT of HBV infection through validated protocols in low and middle income countries with the highest burden of chronic HBV infections is feasible. National scale-up of such protocols is recommended.

Normative references and clinical correlates of fetal umbilical artery Doppler indices in southwestern Nigeria.

OBJECTIVE: To derive normative references for umbilical artery (UA) Doppler indices, including pulsatility index (PI), resistance index (RI), and systolic/diastolic (SD) ratio, for singleton pregnancies in Ile-Ife, Nigeria, and compare them with reference values from other populations. METHODS: A longitudinal study involving 415 women with a singleton fetus at 26-40 gestational weeks attending Obafemi Awolowo University Hospital, Ile-Ife, between July 2015 and March 2019. Fetal UA PI, RI, and SD ratio were measured every 4 weeks until delivery. Reference values from the 2.5th to the 97.5th centiles were derived from 1375 measurements. Correlations between indices and bio-demographic characteristics were assessed; regression equations were generated. RESULTS: The RI, PI, and SD ratio decreased by 0.013, 0.027, and 0.71, respectively, for each additional week of pregnancy. There was a negative correlation between the three indices and birthweight (P<0.001), but not maternal parity, age, or fetal gender. Regression equations for RI, PI, and SD ratio were, respectively, 1.004 - 0.013x, 1.78 - 0.027x, and 4.77 - 0.71x, where x is gestational age (weeks). CONCLUSION: The derived normative references for fetal UA Doppler indices are recommended for monitoring high-risk pregnancies in Nigeria. The indices are comparable to those derived from Norwegian, Thai, and British cohorts.

National data system on near miss and maternal death: shifting from maternal risk to public health impact in Nigeria.

BACKGROUND: The lack of reliable and up-to-date statistics on maternal deaths and disabilities remains a major challenge to the implementation of Nigeria's Road Map to Accelerate the Millennium Development Goal related to Maternal Health (MDG-5). There are currently no functioning national data sources on maternal deaths and disabilities that could serve as reference points for programme managers, health advocates and policy makers. While awaiting the success of efforts targeted at overcoming the barriers facing establishment of population-based data systems, referral institutions in Nigeria can contribute their quota in the quest towards MDG-5 by providing good quality and reliable information on maternal deaths and disabilities on a continuous basis. This project represents the first opportunity to initiate a scientifically sound and reliable quantitative system of data gathering on maternal health profile in Nigeria. OBJECTIVE: The primary objective is to create a national data system on maternal near miss (MNM) and maternal mortality in Nigerian public tertiary institutions. This system will conduct periodically, both regionally and at country level, a review of the magnitude of MNM and maternal deaths, nature of events responsible for MNM and maternal deaths, indices for the quality of care for direct obstetric complications and the health service events surrounding these complications, in an attempt to collectively define and monitor the standard of comprehensive emergency obstetric care in the country. METHODS: This will be a nationwide cohort study of all women who experience MNM and those who die from pregnancy, childbirth and puerperal complications using uniform criteria among women admitted in tertiary healthcare facilities in the six geopolitical zones in Nigeria. This will be accomplished by establishing a network of all public tertiary obstetric referral institutions that will prospectively collect specific information on potentially fatal maternal complications. For every woman enrolled, the health service events (care pathways) within the facility will be evaluated to identify areas of substandard care/avoidable factors through clinical audit by the local research team. A summary estimate of the frequencies of MNM and maternal deaths will be determined at intervals and indicators of quality of care (case fatality rate, both total and cause-specific and mortality index) will be evaluated at facility, regional and country levels. MANAGEMENT: Overall project management will be from the Centre for Research in Reproductive Health (CRRH), Sagamu, Nigeria. There will be at least two meetings and site visits for efficient coordination of the project by regional coordinators and central coordinating staff. Data will be transferred electronically by hospital and regional coordinators and managed at the Data Management Unit of CRRH, Sagamu, Nigeria. EXPECTED OUTCOMES: The outcome of the study would provide useful information to the health practitioners, policy-makers and international partners on the strengths and weaknesses of the infrastructures provided for comprehensive emergency obstetric care in Nigeria. The successful implementation of this project will pave way for the long-awaited Confidential Enquiries into Maternal Deaths that would guide the formulation and or revision of obstetric policies and practices in Nigeria. Lessons learnt from the establishment of this data system can also be used to set up similar structures at lower levels of healthcare delivery in Nigeria.

Clinical versus sonographic estimation of foetal weight in southwest Nigeria.

A prospective study was conducted at Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria, between 3 January and 31May 2004, to compare the accuracy of clinical and ultrasonographic estimation of foetal weight at term. One hundred pregnant women who fulfilled the inclusion criteria had their foetal weight estimated independently using clinical and ultrasonographic methods. Accuracy was determined by percentage error, absolute percentage error, and proportion of estimates within 10% of actual birth-weight (birth-weight of +10%). Statistical analysis was done using the paired t-test, the Wilcoxon signed-rank test, and the chi-square test. The study sample had an actual average birth-weight of 3,255+622 (range 2,150-4,950) g. Overall, the clinical method overestimated birth-weight, while ultrasound underestimated it. The mean absolute percentage error of the clinical method was smaller than that of the sonographic method, and the number of estimates within 10% of actual birth-weight for the clinical method (70%) was greater than for the sonographic method (68%); the difference was not statistically significant. In the low birth-weight (<2,500 g) group, the mean errors of sonographic estimates were significantly smaller, and significantly more sonographic estimates (66.7%) were within 10% of actual birth-weight than those of the clinical method (41.7%). No statistically significant difference was observed in all the measures of accuracy for the normal birth-weight range of 2,500-<4,000 g and in the macrosonic group (> or =4,000 g), except that, while the ultrasonographic method underestimated birth-weight, the clinical method overestimated it. Clinical estimation of birth-weight is as accurate as routine ultrasonographic estimation, except in low-birth-weight babies. Therefore, when the clinical method suggests weight smaller than 2,500 g, subsequent sonographic estimation is recommended to yield a better prediction and to further evaluate foetal well-being.

Effect of hyoscine butyl-bromide on the duration of active phase of labor: A randomized-controlled trial.

OBJECTIVE: Hyoscine butyl bromide (HBB) is known for its antispasmodic action and has been in use for over five decades, there is however no consensus on its effectiveness in the labor process. The aim of this study was to determine the effect of HBB on the duration of the active phase of labor. MATERIALS AND METHODS: A randomized double-blind placebo-controlled clinical trial involving 160 parturient who received either intravenous Hyoscine butyl-bromide (20 mg in 1 ml; n = 80) or intravenous normal saline (1 ml, n = 80). The mean duration of active phase of labor was compared between the two groups. RESULTS: The observed mean duration of the active phase of labor was significantly shorter (P = 0.001) in the Hyoscine butyl-bromide group (365.11 ± 37.32 min, range = 280-490) than in the Placebo group (388.46 ± 51.65 min, range = 280-525). There was no significant difference between the two groups in the mean duration of the second and third stages of labor (20.46 ± 10.46 vs. 23.38 ± 18.95 min, P = 0.43 and 8.96 ± 4.34 vs. 9.23 ± 5.92 min, P = 0.75, respectively). The mean 1-min APGAR scores were also comparable (8.08 ± 1.54 vs. 7.64 ± 1.60, P = 0.08). The mean postpartum blood loss was significantly less in the Hyoscine butyl-bromide group (303 ± 96.52 vs. 368 ± 264.19 ml, P = 0.04). CONCLUSION: Hyoscine butyl-bromide was effective in shortening the duration of the active phase of labor. It was also associated with significantly less postpartum blood loss.

Antenatal corticosteroids for women at risk of imminent preterm birth in low-resource countries: the case for equipoise and the need for efficacy trials.

The scientific basis for antenatal corticosteroids (ACS) for women at risk of preterm birth has rapidly changed in recent years. Two landmark trials-the Antenatal Corticosteroid Trial and the Antenatal Late Preterm Steroids Trial-have challenged the long-held assumptions on the comparative health benefits and harms regarding the use of ACS for preterm birth across all levels of care and contexts, including resource-limited settings. Researchers, clinicians, programme managers, policymakers and donors working in low-income and middle-income countries now face challenging questions of whether, where and how ACS can be used to optimise outcomes for both women and preterm newborns. In this article, we briefly present an appraisal of the current evidence around ACS, how these findings informed WHO's current recommendations on ACS use, and the knowledge gaps that have emerged in the light of new trial evidence. Critical considerations in the generalisability of the available evidence demonstrate that a true state of clinical equipoise exists for this treatment option in low-resource settings. An expert group convened by WHO concluded that there is a clear need for more efficacy trials of ACS in these settings to inform clinical practice.

Sexual assault in Ile-Ife, Nigeria.

BACKGROUND: Sexual assault (SA) is a shattering malevolence against women. This study determined the burden, periodicity, presentation and management of SA in Ile-Ife, Nigeria. MATERIALS AND METHODS: Retrospective analysis of the hospital records of 76 SA survivors managed over a 5-year period (2007-2011) in Obafemi Awolowo University Teaching Hospitals complex (OAUTHC), Ile-Ife. RESULTS: Sexual assault accounted for 0.69% of all female and 5.2% of all gynaecological emergencies in OAUTHC, Ile-Ife. The survivors' ages ranged from 4 to 50 years (mean = 17.7 ± 8.8years) and adolescents made up for 48%. The peak prevalence of SA was in February and December and among adults and under-16-year-old survivors, respectively. Daytime and weekday SA were significantly more common among the under-16-year-old survivors (P = 0.008). Majority of the survivors (62%) knew their assailant(s). Neighbours were the commonest perpetrators identified (28.2%) and the assailants' house was the commonest location (39.4%). Weapons were involved in 29.6% of cases and various injuries were identified in 28.2% of the survivors. Hospital presentation was within 24 hours in majority (76.1%) of the survivors, but rape kit examinations were not performed as the kits were not available. Although appropriate medical management was routinely commenced, only 12.7% of survivors returned for follow-up. CONCLUSIONS: Seasonal and diurnal patterns exist in the prevalence of SA in Ile-Ife and most survivors that reported in the hospital presented early. Rape kit examinations were, however, not executed, due to non-availability. Personnel training, protocol development, provision of rape kits and free treatment of SA survivors are, therefore, recommended. Public enlightenment on preventive strategies based on the observed periodicity and age patterns is also suggested.

Experiences and needs of Nigerian women after stillbirth.

OBJECTIVE: To determine the type of care that Nigerian women would find useful after stillbirth. METHODS: Between January and June 2009, the study consecutively enrolled women attending the prenatal clinic of Wesley Guild Hospital, Ilesa, Nigeria, who had previously had a stillborn infant. The women were asked whether they had been offered any of the following recommended care procedures: (1) see the infant; (2) hold the infant; (3) obtain mementoes; (4) name the infant; or (5) autopsy. They were also asked which of these procedures they found helpful in coping with their loss. Data were collected via an interviewer-administered questionnaire. RESULTS: Of the 45 women interviewed, 24 (53.3%) were given the opportunity to see the body of their infant. None was given the opportunity to hold, take pictures, or name the infant. Thirty (66.7%) wished they had seen their infant, and 8 (17.8%) and 2 (4.4%) wished that they could have held and taken photographs of their infant, respectively. Only 7 (31.82%) women had fully recovered within 3 years of stillbirth. CONCLUSION: Contrary to general beliefs, most women wished to see the body of their stillborn infant and many desired to hold them.

A randomised controlled trial of early initiation of oral feeding after cesarean section.

OBJECTIVE: To evaluate the safety and efficacy of early oral feeding after cesarean delivery. METHODS: Two hundred women who had cesarean section were randomly assigned to early feeding or routine feeding. Women in the early feeding group were encouraged to take sips of water 8 h post-operatively, followed by oral tea of 100 mL at the time of supervision. Women in the routine feeding group were managed by restricting oral intake for the first 24 h and administration of sips of water 24-48 h post-operatively. The outcome measures include the rate of ileus symptoms, post-operative time interval to presence of bowel sounds, passage of flatus and bowel movement, time interval to return to regular diet, length of hospital stay, post-operative complications, acceptability and benefit of early oral feeding. RESULTS: The early feeding group had a shorter mean post-operative time interval to bowel sounds 18.90 +/- 4.17 h versus 36.21 +/- 3.52 h (p < 0.001), passage of flatus 44.81 +/- 3.73 h versus 60.58 +/- 4.40 h (p < 0.001) and bowel movement 58.30 +/- 5.91 h versus 72.76 +/- 4.25 h (p < 0.001). There was no significant difference in paralytic ileus symptoms. Early feeding group had a shorter mean hospital stay 4.80 +/- 0.59 days versus 6.69 +/- 0.71 days (p = 0.001). Early feeding group required less intravenous fluid 7.14 +/- 1.34 bottles versus 11.8 +/- 1.32 bottles (p < 0.001). CONCLUSIONS: Early feeding after cesarean section was well tolerated and safe and can be implemented without an increase in adverse outcome.

Breast-feeding pattern and onset of menstruation among Yoruba mothers of South-west Nigeria.

OBJECTIVE: To determine the breast-feeding practices and duration of lactational amenorrhoea among women within the first year of delivery in a Nigerian population. METHOD: Cross-sectional study carried out between January 2005 and April 2006, among mothers within one year of delivery, who were attending the Infant Welfare Clinic at Wesley Guild Hospital, Ilesa, Nigeria. Using a semi-structured questionnaire, mothers were interviewed to obtain information regarding their socio-demographic characteristics, parity, breast-feeding habits, use of contraception and onset of menstruation after delivery. Information obtained was analysed using the Statistical Package for Social Sciences (SPSS) software version 11. RESULTS: All 268 (100%) mothers interviewed breast-fed their babies, 261 (97.4%) of which for at least 6 months. Most (71.6%) suckled exclusively for 6 months and more; only 10 (3.7%) never carried out exclusive breast-feeding. Age, parity and educational level did not affect the duration of exclusive breast-feeding. Lactational amenorrhoea lasted 3 months or more in 229 (85.5%) of the mothers. Of the 174 who exclusively breast-fed for 6 months, 109 (62.6%) remained amenorrhoeic during that time and, hence, met the criteria for use of LAM contraception. CONCLUSION: Exclusive breast-feeding among nursing mothers is highly prevalent among Yoruba mothers of South-west Nigeria. Since lactational amenorrhoea lasts 6 months in about two-thirds of the women nursing for that period of time, there is a great potential for the application of LAM for contraception.