Choice of delivery positions among multiparous women in Kano

Background: Confining women to hospital bed with limited power of movement and involvement of decision making during labor process and  restricting them to supine position in second stage of labor might contribute significantly to aversion to hospital delivery. Objective: To determine the different delivery positions women take during home delivery. Method: This was a cross sectional survey among 285 multiparous women who had vaginal delivery of life singleton babies. They were interviewed using questionnaire at Murtala Muhammad Specialist hospital Kano on choices of delivery position. Ethical approval was obtained from the ethical committee of the state. Data obtained were analyzed using SPSS Version 19. Qualitative data were summarized using frequencies and percentages. Chi (χ2) test was used for categorical data. A P value of ≤ 0.05 was considered statistically significant. Results: The mean age (±SD) of the respondents was 28.9 ± 7.12 years. Majority of the women that delivered at home assumed the squatting  position for delivery (60%) and were mainly assisted by traditional birth attendants (TBA) (41.3%). Over 50% of those that delivered at home were instructed to take the position they delivered in by their assistants at delivery while those that chose their position by themselves did that because they felt more comfortable in that position (85%). Over 80% of those that were instructed to take a position at delivery did not ask their assistant the reason for advising on that position. There was statistically significant association between educational level and right to decide in which positionto deliver the baby (χ²=28.517, P = 0.000). Conclusion: Squatting position was the most assumed position following home delivery. There was statistically significant association between educational level and right to decide in which position to deliver the baby. Key words: Choices; delivery position; multiparous women; Nigeria; vaginal birth

Choice of specialization among female clinical medical students of Bayero University Kano, Nigeria

Background: The field of medicine is very wide; female medical students also have their choice of specialization which many develop in medical schools due to different factors.Methodology: It was a cross sectional study that was conducted among female clinical medical students of Bayero University Kano. Ethical approval was obtained from the hospital Ethical Committee. Questionnaire was administered to all consenting female students. Data were analysed by SPSS Electronic Software Version 18 (SPSS Inc, IL, Chicago, USA). A P value of less than 0.05 was considered statistically significant.Results: Eighty five female medical students participated in the study. Mean (SD) age was 23.09 ± 1.8 years. Seventy two (84.70%) chose clinical medicine to be their future career while 13 (15.30%) were undecided. Only 15 (22.70%) decided to specialize in their career of choice. Obstetrics and Gynaecology was the most interested speciality of choice (30.80%). Most students were interested in the reward in working in the speciality 54 (68.40%) followed by interest in the clinical work 52 (65.80%). Many of the respondents 41 (49.4%) considered their career development as a priority in future career plans in practice location, and educational environment for children 40 (51.90%). Only 15 (18.00%) were keenly motivated to work in rural areas regardless of the duration of time.Conclusion: Female medical students preferred to be clinicians in their future career with obstetrics and gynaecology as the most interested speciality of choice. Their career development and educational environment for children were the priority in future career plans in practice location.Keywords: Choice of specialization; Female medical students; Kano; Nigeri

Ritual hot bath (wankan jego) in Kano: Are they still practicing? What are the implications?

Background: Postpartum ritual hot bath is one of the harmful cultural beliefs commonly practiced in Northern Nigeria. It is linked with health hazards especially among women with hypertensive disorders of pregnancy. Methodology: It was a cross-sectional study conducted among 199 pregnant women over the period of 3 months. Ethical approval was obtained from The Kano State Ethical Committee. Questionnaire was administered among consenting pregnant women. Information on sociodemographic characteristics and practice of hot bath was obtained. Data were analyzed with SPSS version 17 computer software (SPSS Inc., SPSS Statistics for Windows, Chicago, IL, USA). Results: One hundred and ninety-nine pregnant women were recruited for the survey. The mean age ± standard deviation was 28.09 ± 5.55 years. The rate of hot bath was 56.80% and the days spent taking the hot bath ranged from 4 to 40 days. An average of 195.41 ± 96.050 Naira was spent on firewood per day for the hot bath. The method of boiling the water was mainly the use of firewood 87 (78.40%). They mainly used leaves 76 (68.50%) and towel 35 (31.50%) for bathing. The responsibility of the cost of the hot bath was mainly on husband 102 (91.90%). The hot bath was enforced mainly by the parents 68 (61.30%). Up to 82 (73.90%) of the respondents were ready to abandon the hot bath if alternatives such as drugs are provided. Conclusion: The prevalence rate of hot bath was 56.80%. The burden of its financial implications lies mainly on husbands leading to other social and financial problems

Knowledge, attitude, and perception of pregnant women toward anesthesia for cesarean section at Aminu Kano Teaching Hospital

Background: Anesthesia is regarded as an integral part of cesarean section due to its elimination of pain and discomfort. Pregnant women need to have awareness of anesthesia for cesarean section. Objectives: The aim of this study was to determine the knowledge, attitude, and perception of pregnant women toward anesthesia for cesarean section. Materials and Methods: This was a cross-sectional study among consenting pregnant women at Aminu Kano Teaching Hospital. A structured pretested questionnaire was used to obtain information from the participants. Ethical approval was obtained from the hospital ethics committee. Data obtained was analyzed using SPSS version 18 (SPSS Inc., Chicago, Illinois, 2012, US). Fischer's exact test was used for categorical data and P ≤ 0.05 was considered statistically significant. Results: The mean age ± standard deviation was 28.71 ± 5.635 years. Two hundred and thirty-two (68.8%) had knowledge of anesthesia for surgical procedures, and in up to 221 (65.5%), the anesthesia known to them was for cesarean section. Main sources of knowledge were from the clinic (195, 44.5%) and previous experience/exposure (180, 41.1%). The main anesthetic side effects were headache (24, 64.9%) and delayed recovery (11, 29.7%). Regional anesthesia was preferred (246, 73.0%) over general anesthesia (91, 27.0%) because of safety (258, 44.3%), fear of death (240, 41.2%), and the desire for being awake during the procedure (85, 14.5%). Knowledge of anesthesia was statistically associated with the age groups of the respondents (P = 0.027) and their occupation (P = 0.003). Conclusion: The study revealed high knowledge and awareness of anesthesia for cesarean section among pregnant women and regional anesthesia was preferred over general anesthesia

How citizen scientists are rapidly generating big distribution data: lessons from the Arewa Atlas Team, Nigerian Bird Atlas Project

The Arewa Atlas Team (AAT) in northern Nigeria has set an example for a robust methodological data collection and made a big impact for the African Bird Atlas Project. To broaden national bird atlas projects and coverage across the continent, this paper reports on the activities and protocols of the AAT. We set out how we have galvanised bird clubs and bird club members to participate in this important monitoring project. We then focus on a bird atlas expedition conducted to the Bauchi State as an example. The outing was carried out from 24 to 28 September 2020 in line with the BirdMap protocol. For the first time, the AAT atlased 100 pentads and recorded 8 591 individual birds of 222 species (24.21% of Nigerian birds) from 67 families. We explore what can be done with these data, by presenting a summary of descriptions of the birds observed. For instance, we recorded 184 resident species, nine intra-African and 24 Palearctic migrants. The highest bird abundance (120 individuals) was recorded at 11°00′26.9″ N, 9°29′46.5″ E, pentad 1105C0925. Furthermore, the Rock Firefinch Lagonosticta sanguinodorsalis was out-of-range from Lumba. The Tawny Eagle Aquila rapax (Vulnerable) and Pallid Harrier Circus macrourus (Near Threatened) were species of conservation concern. Results of this survey shows that citizen science is a powerful tool to make rapid biodiversity assessments of bird species richness and abundance and provides insights into bird occurrence and composition. This can be extended to distribution over time at a local geographic scale. Continuous efforts to map bird distributions are therefore recommended, mostly in regions and countries where atlas projects have not been established or still in the formative stages. It is important that bird atlas teams maximise ways to accomplish more noteworthy coverage in their respective national bird atlas projects and here we outline how we accomplished this as motivation and a model for the African Bird Atlas Project. Keywords: African bird atlas project; Bauchi State; bird distribution; bird conservation; volunteers; public awarenes

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research