Editorial - Improving the quality of health services in our tertiary hospitals

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Editorial

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Erratum: Office cystometry in a resource‑constrained setting: Spectrum of diagnoses and correlation with QUID

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Editorial

A new dawn with tropical journal of obstetrics gynaecolog

Comparing the effectiveness of two different dosage regimes of oral nifedipine in the treatment of preterm labour

Objective: To compare the effectiveness and side effect of two different dosage regimes of oral Nifedipine in the treatment of preterm labourMethods: A double blinded randomized controlled trial in which 86 pregnant women with preterm labour were randomized to receive either the low or high dose regimen of Nifedipine for tocolysis. Low dose of 10 mg of oral Nifedipine then 5mg every 15min for 1hr 10mg 6hly for 48hrs, while the high dose was 20 mg of oral Nifedipine followed by 10 mg every 15 minutes for 1hr then 20mg 6hourly for 48 hours. The primary outcome was defined by mean uterine quiescence time and fetomaternal side effect were compared between the groups.Results: The mean uterine quiescence time for the low dose and high dose regime were comparable 13.60±11.69 hours versus 12.16±8.90 hours (P = 0.747) respectively, there was no statistical significance difference. None of the patients in both groups needed rescue treatment. Forty patients (93%) versus 41 patients (95%) (P = 0.506) of low and high dose respectively where able to achieve uterine quiescence within 48hours, there was no statistical significant difference. Maternal headache was higher in the high dose compared to the low dose but not statistically significant {19% vs 5% (p = 0.08)} None of the women in both groups had fetal heart rate abnormality.Discussion: The high dose regimen of oral Nifedipine for tocolysis does not have any advantage over the low dose regime in terms of effectiveness for tocolysis and infact low dose had a lower maternal side effect. Key words: Nifedipine; preterm labour; treatment

Semen quality of male partners of infertile couples in Ile-Ife, Nigeria

Objectives: The objective was to evaluate seminal fluid indices of male partners of infertile couples so as to identify the current status of the contributions of male factor to infertility in our environment.Materials and Methods: This is a prospective study of the seminal fluid indices of consecutively consenting male partners of infertile couples seen at the Fertility and Endocrinology Research unit of the Department of Obstetrics Gynaecology and Perinatology, Obafemi Awolowo University Teaching Hospital Ile-Ife between May 2004 and June 2008.Results: The results of the semen analysis of 661 male partners of the infertile couples were retrieved and analyzed. The patterns of semen parameters noted in infertile males were oligozoospermia, teratozoospermia, asthenozoospermia, azoospermia,  oligoteratozoospermia, oligoasthenozoospermia, and  oligoasthenoteratozoospermia, asthenoteratozoospermia found in 25.6%, 18.5%, 11.5%, 6.2%, 3.2%, 2.3%, 2.1%, and 0.9%, respectively. Among the age groups, age group 31-40 had a higher prevalence of oligozoospermia (13.3%) while among the occupational groups, the civil servants had the highest prevalence of oligozoospermia (12%). There was a high of level of leucocytospermia and bacterial infections in both normospermic and oligospermic semen.Conclusion: This study showed a high rate of abnormal semen quality of male partners of infertile couple in our environment and is an indication for the need to focus on the management of this condition and the institution of preventive program for male infertility. There is urgent need for advocacy for men to accept responsibility for their contribution to infertility and to reduce stigmatization and ostracizing of women for infertility.Key words: Abnormal semen parameters, infertility, male partners, semen analysi

The impact of religion on the contraceptive choice among women in the south west Nigeria

Objective: To determine the frequency of use and the impact of religion on the choice of the available modern methods of contraception among women in a semi-urban area in the Southwest Nigeria.Methods: A total of 848 case reports of the new acceptors of the modern methods of contraception at the family planning unit of the University Teaching Hospital between January 2009 and December 2010 were retrieved. Relevant data regarding biodata and religion characteristics of the clients were collated and analyzed.Results: Overall, 407 of the 848 (48%) clients studied accepted injectable hormonal contraceptives. Very closely, 382 (45%) accepted IUCD. The third and fourth most frequently accepted modern methods of contraception were Oral contraceptive pills 5.5% and implant, 1.2% respectively. Least accepted was the male condom by only 0.2% of the clients. More than half, 509 of the 848 clients (60%) were between 30 – 39 year age brackets, while only 1 client out of the 848 clients was an adolescent below 20 years. Pentecostals (605 out of 848) accounted for the majority (71.3%) ofthe new acceptors of Modern methods of contraception in this study. Only 61(7.2%) were Roman Catholics. Other non-catholic orthodox represented 14 %, while 7.4% were Muslims. There was no significance relationship between the religious denominations and the choice of contraceptive methods among the clients in this study {X2 (35) = 32.04; p>.05}.Conclusion: This study shows clearly that religion to a large extent affects the acceptance of the modern method of contraception. However, there is no significant relationship between religious denomination and the choice of modern methods of contraception in our environment.Keywords: Modern Contraceptive Methods, Acceptance, Choice, Religion, Nigeri

Cervical cancer screening and practice in low resource countries: Nigeria as a case study

Cervical cancer is the most common female genital tract malignancy in Nigeria and majority of the patients present with advanced disease. It is a preventable cancer as there are well‑defined treatable premalignant phases. The objective of the study is to review the burden of cervical cancer, its screening modalities, and practice of screening and treatment in low resource countries with emphasis on Nigeria. This is a review involving internet and literature search. While developed countries have recorded significant reduction in the incidence of cervical cancer owing to organizedscreening programs, treatment of premalignant cervical lesions, and follow‑up of treated cases, developing countries including Nigeria are yet to optimally utilize screening services due to lack of organized population‑based screening programs with only pockets of screening services which are at best opportunistic. This has not reduced the incidence of cancer because only a fraction of the target population is covered. Apart from this, loss to follow‑up is rampant. The level of awareness of cervical cancer and its preventive strategies are low among the population and policymakers in Nigeria. There is no organized screening program, and the few services available are only opportunistic with little or no impact. Development of cervical cancer screening policy and institution of organized screening program targeted at covering ≥80% of population at risk is fundamental. There is also a need for widespread education of the populace on the burden of cervical cancer and the public health importance of the disease using the mass media, counseling at antenatal clinics, and the involvement of men will contribute immensely to reduction in the incidence of cervical cancer. Decentralization of services by incorporation of cervical screening and treatment in primary health care programs will ensure adequate rural‑urban coverage.Keywords: Cervical cancer screening; human papillomavirus, low resource countries; Nigeria; premalignant diseas

Ectopic Pregnancy: Reasons for the High Tubal Rupture Rates in a Nigerian Population

Context: Nigeria has a high incidence of ruptured ectopic pregnancy. Identification of predisposing factors will help reduce morbidity and mortalityAim: To determine the reasons for the high incidence of ruptured ectopic pregnancy.Methods: All cases of ectopic pregnancies managed at Wesley Guild Hospital, Ilesha, Nigeria , between January 2004 and December 2008 were the subjects of this study. The case notes were reviewed to obtain information on the socio demographic characteristics of the patients, clinical history and operative findings.Results: Of the 1,048 gynaecological admissions during the study period 98(9.4%) were for ectopic pregnancy out of which76(96.2%) were ruptured The mean age of the patients was 28.3 years (SD=5.1), majority (82.3%) were married and 68.4% have had one or more previous deliveries.Amenorrhea was present in 66(83.5%). Abdominal pain (98.%), dizziness (62.0%) and vaginal bleeding (44.3%) were the commonest symptoms. Only 30 (38.0%) presented to any medical facility within 24 hours of the onset of symptoms. The ectopic was tubal in 67(84.8%), abdominal in one and could not be specified in 11. Of the tubal pregnancies ampulla (49.3%), cornual (25.4%) and isthmus (15..0%) were the commonest sites. All patients had laparotomy and salpingectomy. There was no maternal death.Conclusion In our community ectopic pregnancy tends to occur more often in parous women and are more commonly located in the isthmio cornual part of the tube. Besides, majority of our women present late making them more vulnerable to ruptured ectopic pregnancy.Key Words: Ectopic, Pregnancy, Complications, Presentation

Survey of the Problems of Girl Child in Ekiti State, Nigeria

Objectives: To determine the prevalence of teenage pregnancy and knowledge of reproductive health problems among adolescent girls in Ekiti State, Southwest Nigeria.Methods: A cross-sectional community based study was conducted. Using convenient random sampling technique, four local government areas were selected. Eligible participants were both in and out of school children between the ages of 13 -18 years. A hundred respondents were sampled from each selected local government, making a total sample size of 400. Consenting participants were administered questionnaire in their homes by trained LGA enumerators. It elicited information on socio-demographic and reproductive health issues. Data collected were subsequently collated and analyzed.Results: Majority of the girls (78%) were still in-school. All were already menstruating, mostly attaining menarche between the age 15-16years. Only 212 (53%) could remember their last menstrual period. Sexual derby mainly occurred around age 15-16years; 53.3% were already sexually exposed. A quarter of respondents had been pregnant before. Only 187 (46.8%) were aware of modern contraception. The girls had a fair knowledge of implication of early sexual derby and unprotected intercourse, though it did not translate to behavioural change.Conclusion: There is a high prevalence of teenage pregnancy and poor reproductive health knowledge among teenagers in Ekiti State. More collective efforts involving parents, community heads, opinion leaders, civil societies and the state are needed to help our girls attain and sustain healthy reproductive behaviours