Risk factors and outcomes of ectopic pregnancies at Aminu Kano teaching hospital, Kano, Nigeria

Objectives: To determine the incidence, risk factors, clinical presentation, morbidity and mortality of ectopic pregnancies at Aminu Kano Teaching Hospital.Methods: It is a retrospective study of patients with ectopic pregnancies treated at Aminu Kano Teaching Hospital (AKTH), Nigeria, from 1st January, 2005 to 31st December, 2009. The record folders were retrieved from the record department of the hospital and analyzed using Epi Info Electronic statistical software. Data on socio-demographic characteristic, clinical features, postoperative outcomes and duration of hospital stay were extracted.Results: One hundred and ninety seven patients were admitted with ectopic pregnancy during the period under review. Their case notes were retrieved giving a retrieval rate of 91.14%. The mean age was 26.72 ± 5.20, the mean parity was 2.03 ±2.33. The major risk factors were past history of induced abortion (26.70%), and sexually transmitted infections (18.30%). Abdominal pains (93.30%), amenorrhoea (60.00%), vaginal bleeding (58.30%), abdominal tenderness (83.30%) and cervical motion tenderness (90.00%) were the major clinical features. The ampulla was involved in 58.33% of cases and salpingectomy was the surgical option in 95.56%. Shock (3.33%) and anaemia (3.33%) were the major complications.Conclusions: The incidence of ectopic pregnancy at Aminu Kano Teaching Hospital is 1.29%. The most important association is with pelvic infection. Therefore, efforts have to be emphasized on prevention, early and vigorous treatment of pelvic and sexually transmitted infections.Key Words: Ectopic pregnancy, Risk factors, Outcomes, Nigeria

Prevalence of malaria and practice of prevention among HIV positive pregnant women at Aminu Kano Teaching Hospital(AKTH), Kano)

A total of 360 primigravidae were studied at AKTH. 180 each of similar age and socioeconomic status were used as cases and controls in a prospective study. There was no statistically significant difference in their practice of malarial prevention at booking. The prevalence of malaria in their blood smears at booking was 32.22%, with the HIV infected cases accounting for23.33%, whilst the HIV uninfected accounted for 8.89%The prevalence of clinical malaria was significantly eight times higher and the prevalence of recurrent malaria was twenty six times higher in the HIV infected primigravidae as compared to the HIV uninfected primigravidae. Review of malarial prophylaxis in HIV infected primigravidae is recommended.Keywords: HIV infected, HIV uninfected, Malaria, Multigravidae, Primigravidae

Birth Preparedness, Complication Readiness and Fathers’ Participation in Maternity Care in a Northern Nigerian Community

The role of men in maternity care in Africa is understudied, despite their economic dominance and decision making power. In a patriarchal society like northern Nigeria, pregnancy and childbirth are often regarded as exclusively women’s affairs. Using data from interviewer administered questionnaires and in-depth interviews; we assessedbirth preparedness, complication readiness and male participation in maternity care in Ungogo, a northern Nigerian community. Majority of pregnancies were unplanned (96%). Only 32.1% of men ever accompanied their spouses for maternity care. There was very little preparation for skilled assistance during delivery (6.2%), savings foremergencies (19.5%) or transportation during labour (24.2%). Young paternal age (adjusted odds ratio [AOR] =1.5, 95% confidence interval [CI]=1.2-2.6), formal education (AOR=1.9, 95%CI=1.1-3.4) and non-Hausa Fulani ethnicity (AOR=2.3, 95%CI=1.4-3.3) were independent predictors of male participation in maternity care. There isa need to increase involvement of men in their partner’s maternity care through peer-led, culturally-sensitive community education and appropriate health system reforms.(Afr J Reprod Health 2010; 14[1]:21-32)

Cancer of the Cervix in Unscreened West African Women

Background: Cancer of the cervix remains an important health problem amongst women worldwide. Widespread comprehensive cervical cancer control programs have resulted in a marked reduction in the incidence and mortality in most developed countries. Developing countries bear over 80% of the global burden, with only 5% of the global resources for the control of cancer. Majority of the cases in these countries present late and are incurable at the time of diagnosis.Aim: To review the presentation and histopathological types of cervical cancer cases seen in Aminu Kano Teaching Hospital Kano, over a sixteen-year period (1995–2010).Materials and Methods: Case records of histopathologically diagnosed cases of cancer of the cervix were retrieved. Demographic data, stage of the tumor at presentation, and histopathologic type were extracted. The results were analyzed using descriptive statistics.Results: Six hundred and sixty gynecological cancers were seen during the study period, with cancer of the cervix accounting for 58.5% (386/660) cases. Among these cases with cancer of the cervix 71.1% (275/386) were grand multiparous and majority 89.7 % 346/386 presented with advanced disease. Squamous cell carcinoma (SCC) accounted for 86.3% (333/386) of the cancers, adenocarcinoma contributed 12.4%,(48/386) and others contributed 1.3% (5/386).Conclusion: Cancer of the cervix is the commonest gynecological cancer at Aminu Kano Teaching Hospital, Kano, Nigeria. SCC is the commonesthistological type. Keywords: Africa, cervical cancer, screenin

Knowledge and utilization of intermittent preventive treatment for malaria among pregnant women attending antenatal clinics in primary health care centers in rural southwest, Nigeria: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Intermittent preventive treatment for prevention of malaria in pregnancy (IPTp) is a key component of malaria control strategy in Nigeria and sulfadoxine-pyrimethamine (SP) is the drug of choice. Despite the evidence of the effectiveness of IPTp strategy using SP in reducing the adverse effects of malaria during pregnancy the uptake and coverage in Nigeria is low. This study set out to assess the use of IPTp among pregnant women attending primary health centres in the rural area and determine factors that influence the uptake.</p> <p>Methods</p> <p>A cross-sectional study was carried out between July and August 2007 among 209 pregnant women selected by systematic random sampling from antenatal care attendees at primary health care in a rural Local Government Area of Ekiti State, Nigeria. Information on knowledge of IPT, delivery, adherence and acceptability was obtained using an interviewer administered questionnaire. Descriptive statistics such as means, range, proportions were used. Chi-square test was used to examine association between categorical variables. All analyses were performed at 5% level of significance.</p> <p>Results</p> <p>One hundred and nine of 209 (52.2%) respondents have heard about IPTp but only 26 (23.9%) were able to define it. Fifty seven (27.3%) reported to have received at least one dose of IPTp during the index pregnancy and all were among those who have heard of IPTp (52.3%). Twenty one of the 57 (36.8%) took the SP in the clinic. Only three of the twenty-one (14.3%) were supervised by a health worker. Twenty two of the 36 women (61.1%) who did not take their drugs in the clinic would have liked to do so if allowed to bring their own drinking cups. Almost half (43.9%) of those who had used IPTp during the index pregnancy expressed concern about possible adverse effect of SP on their pregnancies. Periodic shortages of SP in the clinics were also reported.</p> <p>Conclusion</p> <p>In this study, IPTp use among pregnant women was very low and there was poor adherence to the Directly Observed Therapy (DOT) scheme. Concerted effort should be made to increase awareness of IPTp among the public especially women of child bearing age. Health workers should also be trained and monitored to ensure adherence.</p

Desire for obstetric analgesia among women in northern Nigeria

Background: Obstetric analgesia is now routinely provided in most developed countries. However, in developing countries including Nigeria, childbirth is still a painful natural process for most women without choice. This study determined labour pain perception, awareness and desire for obstetric analgesia among antenatal clients of Aminu Kano Teaching Hospital (AKTH) in northern Nigeria.Methods: A hospital based cross sectional study was conducted in the Antenatal clinic of AKTH from March to April 2010. Questionnaires were filled by verbal interviews conducted on 400 antenatal clients.Results: Of those that have delivered at least once previously (n=284), majority (194, 68.3%) scored labour pain as severe 66(23.2%) said it was moderate while 24 (8.5%) claimed it was mild. Only 15% (n=59) of therespondents were aware of at least one method of obstetric analgesia. The methods mentioned include Epidural (57.6%, n=34), injections (18.6%, n=11), breathing and relaxation (6.8%, n=4), social support (6.8%, n=4) and all the above methods mentioned (10.2%, n=6). Their main sources of information were friends (62.7%, n=37), books (17.0%, n=10), health worker (13.6%, n=8) and the Internet (6.8%, n=4). None have been offered any analgesia during labour. Majority 317 (79.3%) were desirous of pain relief during the delivery of their current pregnancy. On multivariate logistic regression analysis, educational attainment, ethnicity and awareness of methods of obstetric analgesia remained significant predictors of desire for obstetric analgesia.Conclusion: There is a gross unawareness regarding pain relief in labour, but there is strong desire for same. Reforms in labour pain management are recommended offering parturients a range of safe methods to choose from.Keywords: Labour pain, obstetric analgesia, awareness, desire, antenatal clients, Nigeri

Prevalence And Associated Factors For Non Utilisation Of Maternity Care Services In Rural Kano State

Objectives:- To determine the prevalence and the related sociodemographic determinants for non-utilisation of maternity care services in Shekar Maidaki Village, Kano State. Design:- Community based study. Methods:- One of the three wards in Shekar Maidaki Village was randomly selected. A cross sectional survey of all women in the village was carried out to identify mothers of children aged 23 months or less. These mothers were voluntarily recruited into a case – control study using a pretested questionnaire. Results:- The prevalence of non-utilisation of maternity care services amongst the 152 mothers of children aged 23 months and below was 78.3%. The key determinants for non-utilisation are low level of maternal education (P=0.005) high parity (P=0.007) and antenatal care non-attendance (p=0.001). Main reasons for non-hospital delivery are spousal inhibition (36.2%), access to experience TBA (24.1%) and the cost of institutional services (15.1%). Conclusion:- Utilisation of available maternity care services in our rural communities is poor, as a result of high illiteracy rate, cultural barriers and cost of institutional care. Formal education of the girl child, free maternity care and improvement of the quality of care may enhance utilisation. Key words:- Non-utilisation, maternity care services, rural. Highland Medical Research Journal Vol.2(2) 2004: 29-3

Socio-Demographic and Maternal Factors in Anaemia in Pregnancy at Booking in Kano, Northern Nigeria

Anaemia in pregnancy still causes significant maternal morbidity and mortality in the developing countries including Nigeria. The burden and underlying factors are varied even within countries. We studied the prevalence of anaemia at booking and underlying factors in a teaching hospital in northern Nigeria. Using the capillary technique and blood film, the packed cell volume (PCV) and red cell morphology of 300 pregnant women was determined. Additional information was obtained on sociodemographic characteristics, obstetric and past medical history using an interviewer administered questionnaire. Of the 300 pregnant women studied, 51 (17%) [95% Confidence Interval (CI)=12.9%-21.7%] were anaemic. Specifically, 12.7% and 4.3% of the women had mild and moderate anaemia respectively. Blood film of 74.5%, 15.7% and 11.8% anaemic women showed normochromic normocytic, haemolytic and microcytic hypochromic pictures respectively. Low educational attainment [Adjusted Odds Ratio (AOR)=2.13], being single or divorced [AOR=2.02], high parity [AOR=2.06], late booking [AOR=2.71] and short intervals between pregnancies [AOR=2.37] were significant predictors of anaemia in pregnancy. The high prevalence of anaemia in pregnancy related to low educational and economic status especially among women with background obstetric risk factors calls for vigilance, sustained health education and chemoprophylaxis for pregnant women