The High Dependency Unit in the Management of Critically Ill Obstetric Patients in Low Resource Countries

The care of the obstetric population requiring critical care at the intensive care unit is associated with challenges that have made the establishment of obstetric high dependency units (HDU) a priority in the developed, unlike low resource countries.The objective was to evaluate the need to establish obstetric HDUs in low-resource countries.The study was a retrospective descriptive study of obstetric patients admitted in the intensive care unit of the University of Ilorin Teaching Hospital from 1st January 2010 to30th June 2013. Those that were suitable for management at HDUs were compared with those who needed ICU care. The statistical analysis was with SPSS version 20 with p-values, x2, and odds ratio; p-value <0.05 was considered significant.All the 52 patients were postpartum; 16(30.8%) were suitable for HDU care. Of the HDU eligible patients, 11(68.8%) were of low social class, 12(75%) were booked, 11(68.8%) had no further complication at ICU and mortality was 1(6.25%). Compared to those who needed ICU care, there were no statistical significance in maternal age, parity, duration of ICU admission and total cost of ICU care. There were more cases with statistical significance of organ involvement (p<0.001), severity of Glasgow coma score at admission (p<0.001), further complications at ICU (p<0.001) and maternal mortality (p<0.001) among those needing ICU care compared tothose needing HDU care.In conclusion, the establishment of the HDU will reduce cost and the burden on the few ICUs in low-resource countries without increasing maternal mortality

The effects of etonorgestrel implant (ImplanonR) on the lipid profile of Nigerian women

Background: Provision of contraceptive methods with minimal side effects will enhance uptake of contraception particularly in Nigeria where contraceptive prevalence rate remains low. The safety profile of ImplanonR, a long‑acting hormonal subdermal contraceptive containing etonogestrel, has not been adequately evaluated among Nigerian women.Objective: To assess the effects of etonogestrel subdermal implant (ImplanonR) on lipid profile among Nigerian women.Materials and Methods: The study was a longitudinal follow‑up of 54 consenting women selected over a 6‑month period at the Family Planning Clinic of the University College Hospital, Ibadan. After ImplanonR insertion, each woman was followed‑up monthly for a period of 12 months. Fasting venous blood samples were collected for quantification of serum lipids prior to insertion of the implant, then at 1st, 3rd, 6th, 9th, and 12th months of follow‑up.Results: The mean age of the women was 34.4 ± 5.6 with a range of 22–47 years. The modal number of children was 2 ranging from 1 to 6. Total cholesterol (TC) levels showed a general tendency toward a rise. The rise was, however, only significant in the 3rd and 12th months of use. Serum triglycerides showed a tendency toward reduced levels, which were only significant at the 6th and 9th months of use. High‑density lipoprotein (HDL) levels were consistently and significantly elevated above baseline levels. Beyond the 3rd month, low‑density lipoprotein (LDL) levels were lower but not significantly compared with baseline levels. HDL/TC and HDL/LDL ratios were consistently and significantly elevated in comparison with baseline values.Conclusion: Etonogestrel implant seems to cause significant effects on the lipid profile of Nigerian women. The increases were mainly in the HDL fraction, which suggests that the atherogenic and cardiovascular disease risks are reduced. We recommend larger studies to confirm our findings.Keywords: Implanon; laevonorgestrel; subdermal implan

Female adolescents and the future of female genital mutilation/cutting: a report from an endemic area

Background: Despite collaborative efforts aimed at its eradication, Female Genital Mutilation/Cutting (FGM/C) continuesin endemic areas. Objective: To evaluate the experience and preparedness of female adolescents to protect their future daughters from FGM/C. Methods: A cross-sectional survey involving adolescent secondary school girls in North Central Nigeria. Participants were secondary school students who completed the study’s self-administered questionnaire after informed parental or participant’s consent. Data management was with SPSS 20.0 (IBM, USA), P-value <0.05 was significant. Results: There were 2000 participants aged 13-19 years (mean 15.56±1.75), prevalence of FGM/C was 35.0%, awareness was 86.1%, mutilation was performed between infancy and eight years of age (mean 3.85±3.24 years), 644(32.2%) desire to mutilatetheir future daughters, 722(36.1%) expressed support for FGM/C and 63.1% of victims of FM/C reported adverse post-mutilation experiences. Support for FGM/C was associated with low social class (P0.0010), opinion that FGM/C has benefit (P0.001) and desire to mutilate future daughters (P0.001) while awareness of efforts to eradicate FMG/C was 813(40.7%). Conclusion: FGM/C remains prevalent with potential support for its continuation among female adolescents despite reported adverse post-mutilation experiences. The multi-pronged approach to eradicate FGM/C should prioritize re-orientation for adolescent girls, rehabilitation of mutilated girls and girl child formal education. Keywords: Female genital mutilation/cutting; female circumcision, harmful traditional practices, adverse childhood experiences

Pre-and-post-operative aversion among men whose partners had caesarean delivery in a patriarchal setting.

Objectives: The study evaluated pre and post-operative perception and aversion to caesarean delivery (CD) among men whose partners underwent the procedure.Design: A multicentre cross-sectional study.Setting: Two tertiary and two secondary health facilities.Participants: Men whose partners underwent CD at the study sites.Methods: Participants were recruited by purposive sampling, data collection was through interaction via an interviewer-administered questionnaire first immediately the decision for CD was made and thereafter on the third postoperative day. Men whose partners had vaginal delivery were excluded from the study and data management was with SPSS version 21.0 while p<0.05 was significant.Results: Awareness about CD was 84.0% mainly through the healthcare workers (42.1%) and the female partner (34.1%); 88.0% of participants recommended CD for medically-indicated reasons. The greatest influence on consent was the male partner (48.8%). The major pre-operative concerns were limitation of family size (34.7%) and fear of repeat CD (34.0%). Pre-operative perceptions of CD included being expensive (60.7%), fear of the procedure (48.0%), fear of complications (45.3%) and longer hospital stay (44.0%). Aversion to CD was 30.0% pre and 5.3% post-operation; predictors of aversion were history of previous surgery among male or female partner and awareness about CD. However, there were reductions in negative perception and aversion post-operation.Conclusion: The high negative perception and aversion to CD among male partners were reduced post-operation. Healthcare workers should address the concerns and negative perceptions about CD and prioritize patient-friendly experiences during surgical operations

Myomectomy during pregnancy and delivery: is it safe?: Commentary

No Abstract. Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 1-

Intimate partner abuse: wife beating among civil servants in Ibadan, Nigeria

Wife beating is one of the most common forms of violence against women by husbands or other intimate male partners. Although violence against women is pervasive, there are only few studies documenting the magnitude of the problem especially among the working class. The civil service comprises of persons from all socio-economic levels and different backgrounds. They act in advisory capacity and assist those responsible for making state policy. Thus, 431 civil servants of the Oyo State government service were interviewed using a 44-item self-administered questionnaire. Results revealed that prevalence of wife beating was 31.3%. Ninety one (42.5%) men had been perpetrators, while 44 (23.5%) women had been victims. Consuming alcohol and growing up in an environment where parents fight publicly were significantly associated (p < 0.05) with men beating their wives; while being young, unmarried and a parental background of fighting was significantly associated with women being beaten (p < 0.05). Female respondents justified reasons for various types of domestic violence, including beating, more than the males (p < 0.05). Younger respondents had significantly worse attitudes (p < 0.05), while married and educated respondents had better attitude (p < 0.05). “Not wanting the children to suffer” (60.7%) and “hoping that partner will change” (28.8%) were reasons given for remaining in abusive relationships. There is an urgent need for education of the women on their rights, sensitisation of the men on gender-based violence and punishment for perpetrators. Supportive care and counselling services should also be provided for victims of violence. African Journal of Reproductive Health Vol. 9(2) 2005: 54-6