Audit of stillbirths in a Nigerian teaching hospital Kuti

Objective: The purpose of this study is to classify the stillbirths (SBs) in our institution and to determine the avoidable contributors using a pro forma that was developed in our perinatal unit.Materials and Method: All mothers who delivered SBs at Obafemi Awolowo University Hospitals Complex Ile‑Ife, Nigeria, from April 2014 to August 2015 were the subjects of this study. At our weekly perinatal mortality meeting, every SB was reviewed in detail to determine the cause of death and identify gaps in the care. The causes of fetal death were classified using three classification systems – Simplified CODAC, ReCoDe, and our newly developed Ife Perinatal Death Classification System. Remote contributors to fetal demise were assigned using a purpose–designed “Avoidable Factor Proforma” A SB was deemed avoidable if one or more factors were identified.Results: The total number of deliveries during the study was 2,142 with 109 SBs giving a gross SB rate of 51/1000 total births. The SB rate was significantly lower among booked patients than their unbooked counterparts (15 vs. 140 per 1000; P < 0.005). Antepartum death constituted 82.6% of SB among booked patients compared to 41.2% in the unbooked. The most common cause of SB among booked mother was intrauterine growth restriction (21.7%) while obstructed labor (23.3%) was the leading cause among unbooked mothers. Using our classification system, only 3.8% of SBs were unexplained, as against 5.7% for ReCode, and 26.4% for Simplified CODAC. Majority (81.7%) of the SBs were avoidable; and the most common avoidable factor was deficiency in health care. Access to the point of care was not associated with any of the avoidable deaths.Conclusion: Our SB rate remains unacceptably high, with a preponderance of antepartum deaths among booked patients. Majority of the SBs are avoidable dictating the need for training in modern methods of fetal surveillance and improved efficiency of our health‑delivery systems.Keywords: Avoidable Factors , Classification,. Stillbirth

Is menarche really occurring earlier? A study of secondary school girls in Ile-Ife, Nigeria

Context: A secular trend of progressively earlier attainment of menarche has been described in various populations. The existence of this trend in Ile-Ife, Nigeria, has not been documented. Aim: To determine the current age of menarche and its trend in comparison with previous studies among secondary school girls in Ile-Ife, Nigeria. Settings and Design: School-based cross-sectional analytical study. Materials and Methods: Three-hundred secondary school girls in the lower four classes (JSS 1--SSS 1) were studied. Sociodemographic and menstrual data such as cycle length, duration of menstrual flow, and presence of dysmenorrhoea were obtained using a structured self-administered questionnaire. The mean age at menarche was compared with figures from previous local studies to determine the trend in Ile-Ife. Menstrual characteristics were also analyzed. Statistical Analysis: Data was analyzed with SPSS version 20. Means and standard deviations were generated for continuous variables, while frequencies and proportions were determined for categorical variables. Results: Out of the 300 subjects studied, a total of 198 (66%) had attained menarche at the time of this study. Their reported ages at menarche ranged from 11 to 17 years with a mean of 13.08 ± 1.61 years. This was lower than the 13.98 ± 1.30 and 13.94 ± 1.31 years reported in Ile-Ife in 1992 and 1997, respectively. These three figures show a trend of progressive decline in the mean age at menarche. The subjects' mean duration of menstrual flow was 4.26 ± 0.87 days, with 97.5% of them reporting flow of ≤5 days. Only 22 (11.1%) of the respondents had a cycle length of 28 days. Dysmenorrhoea was reported by 75% of the respondents and 24% reported loss of concentration during periods. Conclusion: Similar to the widely reported secular trend, menarche indeed appears to be occurring progressively earlier in Ile-Ife, Nigeria

Upright or dorsal? childbirth positions among antenatal clinic attendees in Southwestern Nigeria

Background: Upright childbirth positions are associated with better delivery outcomes. These positions such as kneeling and squatting were the norm for childbirth in indigenous Nigerian custom. However, westernization has largely replaced them with supine positions. Objective: This study was conducted to compare the knowledge, attitude and experience regarding childbirth positions between antenatal clinic attendees in southwest and northwest Nigeria. Materials and Methods: A mixed methods design was employed. Quantitative data were obtained using a structured questionnaire in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife (n = 201) and Federal Medical Centre, Katsina (n = 104). Knowledge was graded as poor, fair or good whereas attitude toward each position was graded as favoured, indifferent or against. The resulting proportions were compared using Chi-square. Qualitative data were obtained through key-informant interviews. Results: Knowledge of childbirth positions was generally poor. Overall, only to women (0.6%) had good knowledge, whereas 60 (19.7%) had fair knowledge and the rest (79.7%) had poor knowledge. More women in Katsina than Ile-Ife knew the squatting position (32.7% vs. 16.4%; P < 0.001) and favoured it (25.0% vs. 7.5%; P < 0.001), whereas more Ile-Ife women knew the lithotomy position (42.3% vs. 26.9%; P = 0.01). Attitudes towards the remaining positions were comparable between them. Key-informant interviews of the midwives revealed that they were trained to conduct delivery exclusively in the supine positions. They were, however, interested in learning the use of upright positions. Conclusion: Knowledge about childbirth positions was very poor. Women in northwestern Nigeria were more aware and favorably disposed to childbirth in their customary squatting position. Training of Nigerian midwives on upright childbirth positions is recommended

Laparoscopic removal of a large abdominal foreign body granuloma using single incision laparoscopic surgery (SILS) and extraction bag in a cheetah ( Acinonyx jubatus

This case presents a thorn-induced abdominal foreign body granuloma that was removed with single incision laparoscopic surgery and an extraction bag. An 11-yearold female cheetah presented for routine laparoscopic ovariectomy. Abdominal palpation detected a midabdominal mass. Differential diagnoses were neoplasia and foreign body. Laparoscopic exploration of the peritoneal cavity revealed an omentalised mass, which was successfully removed with the aid of bipolar electrocoagulation. Microscopic investigation intraoperatively and postoperatively confirmed extensive foreign body-induced granulomatous inflammation. The foreign body was well encapsulated by fibrous tissue with no adjacent stricture formation. The patient made a complete recovery, and this is the first case report of a thorn-induced abdominal foreign body removed with minimally invasive surgery in a wild African carnivore.http://vetrecordcasereports.bmj.comhb201

The World Health Organization ACTION-I (Antenatal CorTicosteroids for Improving Outcomes in preterm Newborns) Trial: a multi-country, multi-centre, two-arm, parallel, double-blind, placebo-controlled, individually randomized trial of antenatal corticosteroids for women at risk of imminent birth in the early preterm period in hospitals in low-resource countries

BACKGROUND: Antenatal corticosteroids (ACS) have long been regarded as a cornerstone intervention in mitigating the adverse effects of a preterm birth. However, the safety and efficacy of ACS in hospitals in low-resource countries has not been established in an efficacy trial despite their widespread use. Findings of a large cluster-randomized trial in six low- and middle-income countries showed that efforts to scale up ACS use in low-resource settings can lead to harm. There is equipoise regarding the benefits and harms of ACS use in hospitals in low-resource countries. This randomized controlled trial aims to determine whether ACS are safe and efficacious when given to women at risk of imminent birth in the early preterm period, in hospitals in low-resource countries. METHODS/DESIGN: The trial design is a parallel, two-arm, double-blind, individually randomized, placebo-controlled trial of ACS (dexamethasone) for women at risk of imminent preterm birth. The trial will recruit 6018 women in participating hospitals across five low-resource countries (Bangladesh, India, Kenya, Nigeria and Pakistan). The primary objectives are to compare the efficacy of dexamethasone with placebo on survival of the baby and maternal infectious morbidity. The primary outcomes are: 1) neonatal death (to 28 completed days of life); 2) any baby death (any stillbirth postrandomization or neonatal death); and 3) a composite outcome to assess possible maternal bacterial infections. The trial will recruit eligible, consenting pregnant women from 26 weeks 0 days to 33 weeks 6 days gestation with confirmed live fetuses, in whom birth is planned or expected within 48 h. The intervention comprises a regimen of intramuscular dexamethasone sodium phosphate. The comparison is an identical placebo regimen (normal saline). A total of 6018 women will be recruited to detect a reduction of 15% or more in neonatal deaths in a two-sided 5% significance test with 90% power (including 10% loss to follow-up). DISCUSSION: Findings of this trial will guide clinicians, programme managers and policymakers on the safety and efficacy of ACS in hospitals in low-resource countries. The trial findings will inform updating of the World Health Organization's global recommendations on ACS use. TRIAL REGISTRATION: ACTRN12617000476336 . Registered on 31 March 2017