Gynaecological Emergencies in the Tropics: Recent Advances in Management

No AbstractKeywords: Gynaecological emergencies, ectopic pregnancy, unsafe abortion, pelvic infection, adnexal mas

Knowledge and Utilization of the Partograph among obstetric care givers in South West Nigeria

This cross-sectional study assessed knowledge and utilization of the partograph among health care workers in southwestern Nigeria. Respondents were selected by multi-stage sampling method from primary, secondary and tertiary levels of care. 719 respondents comprising of CHEWS - 110 (15.3%), Auxiliary Nurses - 148 (20.6%), Nurse/Midwives - 365 (50.6%), Physicians – 96 (13.4%) were selected from primary (38.2%), secondary (39.1%) and tertiary levels (22.7%). Only 32.3% used the partograph to monitor women in labour. Partograph use was reported significantly more frequently by respondents in tertiary level compared with respondents from primary/secondary levels of care (82.4% vs. 19.3%; X2 = 214.6, p < 0.0001). Only 37.3% of respondents who were predominantly from the tertiary level of care could correctly mention at least one component of the partograph (X2 = 139.1, p < 0.0001). The partograph is utilized mainly in tertiary health facilities; knowledge about the partograph is poor. Though affordable, the partograph is commonly not used to monitor the Nigerian woman in labour. (Afr Reprod Health 2008; 12[1]:22-29).Cette étude transvasale a évalué la connaissance et l\'utilisation du partographe parmi les membres du personnel soignant au sud-ouest du Nigéria. Les personnes interrogées ont été sélectionnées à l\'aide d\'une méthode d\'échantillon à plusieurs étapes à partir des niveaux de soin primaire, secondaire et tertiaire. Au total 719 personnes ont été interrogées, y compris les travailleurs communautaires pour l\'extension des services de santé 110 (15,3%), des infirmières auxillaires – 148 (20,6%), les infirmières / sages–femmes – 365 (50,6%), les médecins – 96 (13,4%) ont été sélectionnées à partir des niveaux primaire (38,2%), secondaire (39,1%) et tertiaire (22,7%). Seuls 32,3% se sont servis du partographe pour surveiller les femmes au travail. L\'utilisation du partographe a été plus fréquent chez les interrogés qui appartiennent au niveau tertiaire par rapport aux intérrogés des niveaux primaire et secondaire de soin (82,4% vs 19,3% ; X2 = 214,6 p < 0,0001). Seules 37,3% des intérrogés qui appartenaient en majorité au niveau tertiaire de soin pouvaient mentionner au juste au moins un constituent du partographe (X2 = 139, p < 0,0001). Le partographe est utilisé surtout dans les établissement de santé tertiaire ; la connaissance du partographe est faible. Bien qu\'il soit abordable, le partographe n\'est pas communément utilisé pour surveiller la femme nigériane au travail.Keywords: partograph, healthcare providers, knowledge, utilization Knowledge and Utilization of the Partograph among obstetric care givers in South West NigeriaAfrican Journal of Reproductive Health Vol. 12 (1) 2008: pp. 22-2

Utilization of the partograph in primary health care facilities in Southwestern Nigeria

No Abstract

Attitude of health care workers to patients and colleagues infected with human immunodeficiency virus

Discrimination against persons living with HIV/AIDS in hospital settings has been documented. This study examined the attitude of health care workers (HCWs) to nurses, doctors and patients infected with HIV. A total of 345 respondents selected by multistage sampling techniques were surveyed, using a semi-structured questionnaire, which explored respondents’ attitude to HIV-infected patients and colleagues with HIV/AIDS. HCWs were unwilling to accept that medical procedures be carried out on them by HIV-infected doctors and nurses, with almost 80% refusing surgery or assistance at surgery on them by an HIV-infected doctor or nurse. They were also significantly more unwilling to accept that medical procedures be carried out on them by an infected colleague, compared with their carrying out the same procedure on an HIV-infected patient. Thus, HCWs seemed to believe that the risk of contracting HIV was higher if an infected HCW were to perform medical procedures on them, and fear of contracting HIV seemed to be the driving force for their negative attitudes. Education on occupational risks of HIV, provision of a safe working environment with enforcement of universal precautions, as well as provision of post-exposure prophylaxis are suggested as ways to enable HCWs to change their attitudes

Pharmacological Exposure of Pregnant Mothers in Ilorin, Nigeria

Context: Use of drug during pregnancy is a universal event. However, in developing countries, drug use is poorly controlled as most of the drugs could be obtained without prescription. This constitutes potential hazard both for the mother and the fetus.Objective: To determine the pattern of drug use (including alcohol and smoking) prescription and non prescription of drug by pregnant mothers in Ilorin, Kwara State, Nigeria.Study Design: A cross sectional study of pregnant mothers attending antenatal clinic of the University of Ilorin Teaching Hospital, Ilorin.Result: Four hundred 400 pregnant women participated in the study, 335 adequately completed questionnaire for data analysis. Majority of the respondents 273 (81.5%) had taken one or more drugs, 62 (18.5%) had not used any. Average number of drugs used was 2.7. Routine haematinics (folic acid and Ferrous Sulphate) are the common drug taken by 241 (81.5%) of the respondents. Anti malarial drugs were taken by 47 (14%) while herbal drug was taken by 41 (12.2%). Five (1.5%) of the respondents admitted to taking alcohol and only one woman (0.3%) admitted to smoking cigarette. One (0.3%) each of the respondents was on anti depressant and anticonvulsant drugs. Occupation was significantly related to herbal use. Parity was also significantly related to alcohol consumption and the use of unprescribed drugs.Conclusion: Drug use is common during pregnancy. Haematinics were the commonest drug used. Herbs are used to some extent and antimalarials are underutilized. Alcohol is minimally used and smoking during pregnancy is virtually non- existent. There is need to caution our pregnant mothers on the use of herbs as there is no full understanding of their pharmacokinetics

Attitudes to female genital mutilation/cutting among male adolescents in Ilorin, Nigeria

Background. The central role of males in female reproductive health issues in patriarchal societies makes them an important group in the eradication of female genital mutilation/cutting (FGM/C).Objectives. To determine knowledge about and attitudes to FGM/C among male adolescents, and their preparedness to protect their future daughters from it.Methods. A cross-sectional survey among male adolescent students in Ilorin, Nigeria. Participants completed a self-administered questionnaire after consent had been obtained from them or their parents. Statistical analysis was with SPSS version 20.0 (IBM, USA). A p-value of &lt;0.05 was taken as significant.Results. Of 1 536 male adolescents (mean age 15.09 (standard deviation 1.84) years, range 14 - 19), 1 184 (77.1%) were aware of FGM/C, 514 (33.5%) supported female circumcision, 362 (23.6%) would circumcise their future  daughters, 420 (27.3%) were of the opinion that FGM/C had benefits, mostly as a necessity for womanhood (109, 7.1%), and 627 (40.8%) perceived it as  wickedness against females; 546 (35.5%) were aware of efforts to eradicate FGM/C, and 42.2% recommended education as the most important intervention to achieve this.Conclusion. Education and involvement in advocacy may transform male adolescents into agents for eradication of FGM/C

Predictors for neonatal death in the rural areas of Shaanxi Province of Northwestern China: a cross-sectional study

Background Almost all (99%) neonatal deaths arise in low-income and middle-income countries. Approximately 450 new-born children die every hour, which is mainly from preventable causes. There has been increased recognition of the need for these countries to implement public health interventions that specifically target neonatal deaths. The purpose of this paper is to identify the predictors of neonatal death in Type 4 rural (poorest) counties in Shaanxi Province of northwestern China. Methods A cross-sectional study was conducted in Shaanxi Province, China. A single-stage survey design was identified to estimate standard errors. Because of concern about the complex sample design, the data were analysed using multivariate logistic regression analysis. Socioeconomic and maternal health service utilization factors were added into the model. Results During the study period, a total of 4750 women who delivered in the past three years were randomly selected for interview in the five counties. There were 4880 live births and 54 neonatal deaths identified. In the multiple logistic regression, the odds of neonatal death was significantly higher for multiparous women (OR = 2.77; 95% CI: 1.34, 5.70) and women who did not receive antennal health care in the first trimester of pregnancy (OR = 2.49; 95% CI: 1.41, 4.40). Women who gave birth in a county-level hospital (OR = 0.18; 95% CI: 0.04, 0.86) and had junior high school or higher education level (OR = 0.20; 95% CI: 0.05, 0.84) were significantly protected from neonatal death. Conclusions Public health interventions directed at reducing neonatal death should address the socioeconomic factors and maternal health service utilization, which significantly influence neonatal mortality in rural China. Multipara, low educational level of the women, availability of prenatal visits in the first trimester of pregnancy and hospital delivery should be considered when planning the interventions to reduce the neonatal mortality in rural areas

Malaria knowledge and agricultural practices that promote mosquito breeding in two rural farming communities in Oyo State, Nigeria

<p>Abstract</p> <p>Background</p> <p>Agricultural practices such as the use of irrigation during rice cultivation, the use of ponds for fish farming and the storage of water in tanks for livestock provide suitable breeding grounds for anthropophylic mosquitoes. The most common anthropophylic mosquito in Nigeria which causes much of the morbidity and mortality associated with malaria is the anopheles mosquito. Farmers are therefore at high risk of malaria - a disease which seriously impacts on agricultural productivity. Unfortunately information relating to agricultural practices and farmers' behavioural antecedent factors that could assist malaria programmers plan and implement interventions to reduce risk of infections among farmers is scanty. Farmers' knowledge about malaria and agricultural practices which favour the breeding of mosquitoes in Fashola and Soku, two rural farming communities in Oyo State were therefore assessed in two rural farming communities in Oyo State.</p> <p>Methods</p> <p>This descriptive cross-sectional study involved the collection of data through the use of eight Focus Group Discussions (FGDs) and the interview of 403 randomly selected farmers using semi-structured questionnaires. These sets of information were supplemented with observations of agricultural practices made in 40 randomly selected farms. The FGD data were recorded on audio-tapes, transcribed and subjected to content analysis while the quantitative data were analyzed using descriptive and inferential statistics.</p> <p>Results</p> <p>Most respondents in the two communities had low level of knowledge of malaria causation as only 12.4% stated that mosquito bite could transmit the disease. Less than half (46.7%) correctly mentioned the signs and symptoms of malaria as high body temperature, body pains, headache, body weakness and cold/fever. The reported main methods for preventing mosquito bites in the farming communities included removal of heaps of cassava tuber peelings (62.3%), bush burning/clearing (54.6%) and clearing of ditches (33.7%). The dumping of cassava tuber peelings which allows the collection of pools of water in the farms storage of peeled cassava tubers soaked in water in uncovered plastic containers, digging of trenches, irrigation of farms and the presence of fish ponds were the observed major agricultural practices that favoured mosquito breeding on the farms. A significant association was observed between respondents' knowledge about malaria and agricultural practices which promote mosquito breeding. Respondents' wealth quintile level was also seen to be associated with respondents' knowledge about malaria and agricultural practices which promote mosquito breeding.</p> <p>Conclusion</p> <p>Farmers' knowledge of malaria causation and signs and symptoms was low, while agricultural practices which favour mosquito breeding in the farming communities were common. There is an urgent need to engage farmers in meaningful dialogue on malaria reduction initiatives including the modification of agricultural practices which favour mosquito breeding. Multiple intervention strategies are needed to tackle the factors related to malaria prevalence and mosquito abundance in the communities.</p

Male responsibility and maternal morbidity: a cross-sectional study in two Nigerian states

<p>Abstract</p> <p>Background</p> <p>Nigeria continues to have high rates of maternal morbidity and mortality. This is partly associated with lack of adequate obstetric care, partly with high risks in pregnancy, including heavy work. We examined actionable risk factors and underlying determinants at community level in Bauchi and Cross River States of Nigeria, including several related to male responsibility in pregnancy.</p> <p>Method</p> <p>In 2009, field teams visited a stratified (urban/rural) last stage random sample of 180 enumeration areas drawn from the most recent censuses in each of Bauchi and Cross River states. A structured questionnaire administered in face-to-face interviews with women aged 15-49 years documented education, income, recent birth history, knowledge and attitudes related to safe birth, and deliveries in the last three years. Closed questions covered female genital mutilation, intimate partner violence (IPV) in the last year, IPV during the last pregnancy, work during the last pregnancy, and support during pregnancy. The outcome was complications in pregnancy and delivery (eclampsia, sepsis, bleeding) among survivors of childbirth in the last three years. We adjusted bivariate and multivariate analysis for clustering.</p> <p>Findings</p> <p>The most consistent and prominent of 28 candidate risk factors and underlying determinants for non-fatal maternal morbidity was intimate partner violence (IPV) during pregnancy (ORa 2.15, 95%CIca 1.43-3.24 in Bauchi and ORa 1.5, 95%CI 1.20-2.03 in Cross River). Other spouse-related factors in the multivariate model included not discussing pregnancy with the spouse and, independently, IPV in the last year. Shortage of food in the last week was a factor in both Bauchi (ORa 1.66, 95%CIca 1.22-2.26) and Cross River (ORa 1.32, 95%CIca 1.15-1.53). Female genital mutilation was a factor among less well to do Bauchi women (ORa 2.1, 95%CIca 1.39-3.17) and all Cross River women (ORa 1.23, 95%CIca 1.1-1.5).</p> <p>Interpretation</p> <p>Enhancing clinical protocols and skills can only benefit women in Nigeria and elsewhere. But the violence women experience throughout their lives – genital mutilation, domestic violence, and steep power gradients – is accentuated through pregnancy and childbirth, when women are most vulnerable. IPV especially in pregnancy, women's fear of husbands or partners and not discussing pregnancy are all within men's capacity to change.</p