Maternal mortality audit in a tertiary health institution in Nigeria: Lessons from direct causes and its drivers

Introduction: Nigeria has the second highest number of maternal deaths in the world.The study aimed at determining the causes of and non-obstetric contributors to maternal mortality at a tertiary referral hospital.Materials and Methods: It was a prospective audit of all consecutive maternal deaths in the hospital over a three-year period. Immediately after the death,information was retrieved via a data collection form.Data were analysed with SPSS-20.Results: Seventy deaths were examined over the study period. Maternal mortality ratio was 1,265/100,000 live births.The annual ratio decreased steadily over the study period.Most of the deaths were of multiparous women who had not received any antenatal care,and were mostly postpartum, within 24 hours of delivery.Most of them were critically ill on admission to the hospital. Major causes of death were haemorrhage (36%), sepsis (17%) and hypertensive disorders (16%).Delays were identified in 34.3% of cases;most (70.1%) were Phase III delays.Discussion: Direct causes of maternal mortality are consistent with those found in literature. Steps which the centre has been taken to counter direct and non-obstetric causes are discussed. Possible strategies to improve health financing and referral system are proffered.Keywords: Maternal mortality,delay

Effects of Trichoderma-treated cassava waste in the diets of West African dwarf goat on blood, reproductive and urinary parameters

A study was conducted to evaluate effects of Trichoderma-treated cassava waste on the haemotology, reproductive and urinary parameters of West African dwarf (WAD) does. Twenty mature WAD does were allotted randomly to one four treatments using a completely randomized design arrangement. Does were individually fed the experimental diets containing 0, 20, 30 and 40% fungus treated cassava waste based diets (A, B, C and D, respectively) during the 56 days experiment. The blood parameters (PCV, Hb, RBC and WBC) of animals fed the tested diet compared with those fed the control diet are similar (p>0.05). Likewise, the pH, urea concentration of the urine were comparable (P>0.05) in does fed the experimental and control diets while the urobilinogen was normal across the diets. Fertility, fecundityand prolificacy rates showed better reproductive performance with diet D compared to that of diets A, B and C. These data indicate that addition of Trichoderma-treated cassava waste in the diet of goats hadno detrimental effect on the haematological, urinary and reproductive performances of lactating WAD does

Viral infections among couples for assisted reproduction in a fertility clinic in Nigeria

Context: The risk of laboratory cross‑contamination may limit the availability of assisted conception for couples infected with chronic viruses. However, assisted conception is the standard of care for people living with human immunodeficiency virus (HIV) to minimize risk of transmission or reinfection.Aims: To assess the burden of viral infection among couples that present for assisted reproductive technology (ART) with a view to evaluating implications for their care.Settings and Design: A cross‑sectional descriptive study carried out among 138 couples at a private fertility clinic in Nigeria.Materials and Methods: Screening for HIV, hepatitis B virus (HBV) and hepatitis C virus were carried out among these clients. The males’ seminal parameters were analyzed according to World Health Organization (WHO) criteria.Statistical analysis Used: Statistical Package for Social Sciences was employed. Analysis was by Chi‑square test; statistical significance was set at 0.05.Results: Viral infections were found in 10/138 women (7.2%) and 15/138 (10.9%) men. The most prevalent infection was HBV. Twenty‑one couples were sero‑discordant. Two couples had concordant HIV and HBV infections, respectively. There was no significant association between sperm quality and chronic hepatitis infection.Conclusion: Nearly a fifth of the couples had at least one partner infected with a chronic virus – a proportion significant enough to demand attention. Apart from separate laboratory and storage facilities, basic principles to minimize transmission are recommended: HBV vaccination in sero‑discordant partners of HBV carriers (and immunoprophylaxis for the baby) and antiretroviral therapy for HIV‑positive partners to reduce the viral load before fertility treatment is commenced.Key words: Assisted reproduction, hepatitis B virus, hepatitis C virus, human immunodeficiency viru

Poverty Alleviation Programmes and Economic Development in Nigeria: A Comparative Assessment of Asa and Ilorin West Local Govt. Areas of Kwara State, Nigeria

This study investigates into the impact of government programmes towards poverty alleviation on the inhabitants of Nigeria with special reference to Asa and Ilorin West Local Government Areas of Kwara State. A focus group discussion (FGD) of 4 groups (2 males and 2 females) was conducted from whose scenario a questionnaire was raised. Both qualitative and quantitative methods were employed especially to see the impact of those policies on the inhabitants using household income as a proxy. The Sen's Gini coefficient revealed that agricultural sector is the highest income-contributing sectorand worst hit income inequality group with about 84percent of totalpopulation in high poverty margin/region among the whole sectors studied. The study also acknowledged the existence of either one poverty alleviation program at one time or the other, but often the policy targets are at variance with the outcome. The study thus that suggests a kind of performance evaluation towards reappraising and adjusting the instruments employed by the programmes, refocus on the important sector(s) in the area of finance and credit facilities and organized buffer stock against agricultural s or bumper harvest in order to sustain price stability

The epidemiology of, and risk factors for, oro-genital and anal human papillomavirus infections among sexually active Nigerians in Ibadan: a mixed methods study

Background: Human papillomavirus (HPV) is primarily transmitted by unprotected sexual behaviours, and persistence of this virus is associated with HPV-related cancers of the cervix, anus, vulvar, oral cavity and penis. Nigeria has one of the highest burdens of cervical cancer, but there is a paucity of data on other HPV-related cancers. Research objectives: To describe the epidemiology of HPV and the pattern of genital, oral and anal sexual intercourse and their association with the prevalence of genital, oral and anal HPV infections among adolescents and young adults and female sex workers (FSWs) (18-45 years) in Nigeria. Methods: First, a systematic review of reported oral and anal sex among heterosexual adolescents and adults in sub-Saharan Africa (SSA) was conducted. Second, a qualitative study that enrolled adolescent girls and young women in the community and in brothel-based FSW in Ibadan, Nigeria was conducted. The study used focus group discussions and in-depth interviews to collect data on definitions or meanings, attitudes and interpretations of different sexual behaviours. Third, a cross-sectional survey was conducted in Ibadan amongst girls and young women and FSWs to measure the prevalence and risk factors of oral, vulvar, cervical and anal HPV infections. Participants were interviewed, had a clinical examination and samples were collected for HPV genotyping. Blood samples were also collected for human immunodeficiency virus testing. Results: The systematic review showed that oral and anal sex are commonly practiced in SSA, particularly among adolescents, young adults and FSWs. In the qualitative study, most participants had heard of oral and anal sex; more adolescents and FSWs had heard of these practices than adults. Local terminology/slang terms for oral and anal sex were acceptable to adolescents and FSWs but adults in the community often disapproved of these terms for framing interview questions. The most common motivations for practicing oral and anal sex were protection of sexual relationships and financial benefits. Concerns about these practices included fear of acquiring diseases and physical injury. For the prevalence survey, 310 women, and 315 FSWs participated. Ever having practised oral sex was three times more frequently reported by FSWs than general population girls and women. Only one woman in the general population and eight FSWs had ever engaged in anal sex. The prevalences of any HPV genotypes were higher in FSWs than in general population 4 girls and women in the vulva (88% versus 69%), cervix (84% versus 60%), anal cavity (75% versus 57%) and oral cavity (24% versus 16%). The prevalence of HPV was significantly higher in adolescents and young adults than in adults in the cervix, vulvar and anal cavity in the two surveys. In the adjusted model, there were higher odds of cervical HPV infection among women with concomitant vulvar (Adjusted odds ratio (aOR)= 12.85, 95% CI, 5.70-28.99), oral (aOR= 4.37, 95% CI, 1.50-12.71) and anal (aOR=3.48, 95%CI, 1.74-6.96) HPV infection while women with concomitant cervical (aOR=22.19, 95 %CI 7.85-62.72) and anal (aOR=6.68, 95% CI 2.44-18.26) HPV infections had higher odds of vulvar HPV infection. The odds of having anal HPV infection was associated with history of concomitant cervical (aOR=4.10, 95% CI, 1.85- 9.11) and vulvar (aOR=5.47, 95% CI, 2.11-14.20) HPV infection. Only the history of concomitant cervical HPV (aOR=4.81, 95% CI, 1.58-14.62) was associated with a higher odd of oral HPV. Among the FSWs, history of concomitant vulvar HPV infection was associated with higher odds of cervical (aOR=16.60, 95% CI, 5.08-47.54) and anal (aOR=10.55, 95% CI, 3.67- 30.31 HPV infection, whereas history of concomitant cervical (aOR=6.48, 95% CI, 2.70-15.57) and anal (aOR=8.88, 95% CI, 3.66-23.28) HPV was associated with higher odds of vulvar HPV infections. The socio-demographic, behavioural and other biological factors that were associated with any HPV infections in specific anatomic sites are presented in the relevant chapters. Conclusion: Adolescents and adults, including FSWs in Ibadan, frequently engaged in different sexual behaviours, which might predispose them to sexually transmitted infections. HPV infection was found to be common among sexually active girls and women, with a higher prevalence among FSWs

Surgical Patients\' Knowledge and Acceptance of Autologous Blood Transfusion.

Background: Homologous blood transfusion carries a well-documented array of risks especially in an HIV endemic environment like Nigeria. It is therefore imperative to consider other forms of restoring blood volume in surgical patients. Autologous blood transfusion (ABT) is one of the ways the problem of HIV transmission can be reduced among surgical patients. The knowledge and acceptability of ABT among surgical patients about ABT, especially pre-donated ABT were assessed. It also assessed whether or not surgeons inform elective surgical patients about this alternative Materials And Methods Questionnaires were distributed among elective surgical patients that presented during the study period. The knowledge, willingness and the factors influencing the willingness of the patients to participate in ABT were investigated. The data were analyzed with SPSS Version10. Results Of the 116 patients [71 males; 45 females] interviewed, 29 (25.0 %) had heard about ABT, 80 (69.0 %) patients had never heard about ABT while 7 (6.1 %) were not sure. Of the 29 respondents who had heard about ABT, only 2 had had ABT. Of the 48 patients who needed blood for current surgical problems, only 4 (9.3 %) would have ABT. There was a significant difference in the number of respondents who believed that ABT is better than homologous transfusion (x2 = 69.11, p < 0.001). Conclusion The knowledge of ABT is low among our surgical patients and surgeons should present this alternative to their patients. The acceptance of ABT may also help in reducing or eliminating HIV transmission via blood transfusion. Keywords: homologous, hepatitis, surgical procedures, blood volume.Sudan Journal of Medical Sciences Vol. 3 (2) 2008: pp. 109-11

Obstetric fistulae repair in a Nigerian Tertiary Health Institution; Lessons learnt from the outcome of care

This was a hospital based retrospective study of one hundred and fifty-five women managed for obstetric vesicovaginal fistula at the University College Hospital, Ibadan Nigeria from 2000 till 20006. The objective of the study was to document the types of obstetric vesico-vaginal fistula and also describe factors that may influence the outcome of successful repair.The pattern of the fistulae managed were Midvaginal (45.8%),  juxtacervical (38.7%) and juxtaurethral (15.5%). Gynaecologists performed 61.7% of cases using the vaginal route while urologists repaired the rest abdominally. Bivariate analysis showed that younger age at presentation, gravidity, VVF type (Anatomic and Kees Waaldijk), number of previous repairs, and presence of rectovaginal fistula and duration of urinary incontinence prior to repair were statistically significantly related to outcome of repair. Multiple logistic regression models revealed age at presentation (95% CI OR = 1.18 – 9.09) and duration of incontinence (95% CI OR = 1.39 – 13.64) as significant predictors. It is recommended that early presentation for repair and capacity building of specialist trainees will assist in the effective management and other interventions to eliminate obstetric fistula. Above all, governments at all levels should either subsidize or make antenatal care free so as to reduce the incidence of childbirth complications including vesico-vaginal fistula.Keywords: Obstetric fistula, vesico-vaginal fistula (VVF), obstructed labou

Determinants of patient satisfaction with physician interaction: a cross-sectional survey at the Obafemi Awolowo University Health Centre, Ile-Ife, Nigeria

Background: Patient satisfaction influences the outcomes of the physician-patient encounter. Patient satisfaction has become a significant health care outcome and a useful indicator of the quality of care. The aim of the study was to assess the level of satisfaction among Obafemi Awolowo University Health Centre attendees in relation to physician-patient interaction and ascertain the relationship between the different aspects of physician-patient interaction, patient satisfaction and adherence intent.Methods: Demographic information and information on patients’ feelings about their doctors was collected from 300 consenting patients in a cross-sectional survey, using an adapted Medical Interview Satisfaction Scale self-administered questionnaire. Data were analysed with SPSS version 11. Logistic regression was conducted to identify the factors predicting patient satisfaction and adherence intent.Results: Of the 300 patients studied, 63.3% were generally satisfied with their physician-patient interaction. Nineteen per cent of patients were uncertain of their level of satisfaction. Patient satisfaction was positively associated with adherence intent. Patient confidence in the doctor and good communication skills and information provision on the part of the doctor predicted patient satisfaction, while patient confidence in the doctor and information provision by the doctor predicted adherence intent.Conclusions: A fifth of the study subjects were dissatisfied with their doctor-patient relationship. This study suggests the need for primary care physicians to be aware of the important place of interpersonal skills development in the application of medical knowledge and expertise in the provision of health care.Keywords: patient satisfaction; doctor-patient interaction; adherence intent; patient outcome

Knowledge and use of emergency contraception by medical doctors on internship in a tertiary healthcare facility in Nigeria

Context: Emergency contraception (EC) is widely used to prevent unwanted pregnancy and it is largely adopted in many countries as over the counter drug to improve access.Aims: To determine and compare the correct knowledge, attitude and current use of EC among newly graduated medical doctors (MDs).Settings and Design: A cross.sectional study conducted among 255 newly graduated MDs at the University College Hospital, Ibadan, Nigeria.Materials and Methods: A pretested self.administered questionnaire was used to obtain data from consenting participants.Statistical Analysis Used: Descriptive, bivariate, and multivariable analyses were performed, and statistical significance was set at 0.05. Statistical Package for Social Science version 15.0 (Chicago, IL, USA) software was used.Results: The mean age of the respondents was 27.2 years (standard deviation = 2.1). The commonest indication for emergency contraceptive use mentioned was rape.96.5%. About 70% support EC in Nigeria, while about a quarter (26.9%) routinely counsel women about ECP use. About 21% of respondents currently use EC. Logistic regression analysis revealed significant results for gender [odds ratio (OR) =3.64; 95% confidence interval (CI) OR = 1.31.10.01), religion (OR = 0.26; 95% CI OR =  0.11.0.630) and marital status (OR = 0.19; 95% CI = 0.07.0.56). Conclusion: The correct knowledge and professional disposition toward EC as a form of contraception is low. We recommend that in.service training  should focus more on EC to improve the quality of their knowledge and  attitude towards it.Key words: Emergency contraception, knowledge, Medical Doctor, Nigeri

Short CommunicationAttitude of Infertile Women to Child Adoption in Nigeria

Infertility has serious consequences especially in Africa where a high premium is place on child bearing. An interviewer-administered questionnaire was administered on 396 consenting women seeking infertility treatment at the gynaecological clinic of the University College Hospital, Ibadan in an attempt to assess the attitude of infertile women in Nigeria to child adoption and its acceptability as a management option for infertility. Most (64%) believed its culturally unacceptable and only 17% will try it as an option. Sustained advocacy, community mobilization and enactment of supportive laws were some of the suggestions made by respondents to improve its uptake.Keywords; Infertility, Adoption, Assisted ConceptionNig. J. Physiol. Sci. 25(2010) 47 – 4