AWARENESS, RISK PERCEPTION AND PRACTICE OF SELF-MEDICATION AMONG PREGNANT WOMEN ATTENDING ANTE-NATAL CLINICS IN SOKOTO, NIGERIA

Background: In addition to its adverse health effects on mother and fetus, self-medication is believed to be one of the main driving forces behind the increasing burden of antimicrobial resistance worldwide. This study aimed to assess the awareness, risk perception and practice of self-medication among pregnant women attending ante-natal clinics in Sokoto, Nigeria. Materials and Methods: A cross-sectional study was conducted among 315 pregnant women (selected by a two-stage sampling technique) attending the antenatal clinics of the Primary Healthcare Centres in Sokoto metropolis, Nigeria. Data were collected with a set of pretested, interviewer-administered, structured questionnaire. Data analysis was done using IBM SPSS version 20 statistical package. Results: Whereas, almost all the respondents (98.4%) were aware of self-medication, less than half of them (47.3%) perceived it as a serious threat to their health and the health of their unborn baby. Majority of respondents (67.9%) had self-medicated, with the most commonly self-medicated drugs being analgesics/antipyretics (35.1%), antimalarials (31.3%) and antibiotics (24.3%). The most commonly cited reasons for self-medicating were financial problems (28.5%), lack of the required drugs in the hospital (16.8%), lack of time (12.6%), and sickness being mild (9.8%). Self-medication practice was influenced by respondents’ age, marital status, educational background and perception of risk. Conclusion: This study showed low risk perception and high prevalence of self-medication among pregnant women in Sokoto, Nigeria. Sensitization of members of the public on the hazards of self-medication, poverty alleviation, and provision of comprehensive healthcare services at subsidized prices for pregnant women are hereby suggested. Keywords: Awareness, risk perception, practices, self-medication, pregnant wome

Determinants of mother to child transmission of HIV among HIV exposed infants managed in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Background: Mother to child transmission of HIV (MTCT) is globally known to be the major route of spread of HIV to the unborn fetus and neonate. Many factors related to the mother, infant or the type of HIV virus interplay to increase the risk of MTCT of the virus. Antepartum antiretroviral drugs administration reduces the maternal viral load therefore lowering   the risk of transmission. The objective is to determine infection rate and assess determinants of MTCT of HIV exposed infants delivered in UDUTH Sokoto.Methods: It was a 5-year retrospective study. Records of all HIV positive pregnant women and their babies managed in UDUTH were reviewed from the E health system of the hospital. Patient’s details were recorded from booking to delivery for the period under study. The infant’s records were retrieved and information from delivery to 18 months post-delivery obtained. Structured data collection tool was developed to compile the required information. Data was analyzed using SPSS IBMS 22. Descriptive statistics and comparisons between variables were made statistically using Chi square. P value of   ≤ 0.005 was considered as significant.Results: Records of all the patients recruited were all available for evaluation because authors use the E-health system of records keeping in our hospital. MTCT rate was 0.92%. Majority 60 (47.2%) were within age group 26-30yrs. The subjects were predominantly house wives 97(71.4%) and multipara 77 (60.6%). Viral load ranged between 112 to 28228 copies/ml. Twenty-two (17.3%) had CD4 count less than 250 cells/µl while 61 (48%) had counts above 500cells/µl. All were in WHO clinical stage 1-3. All were on triple regimen anti-retroviral drugs. Spontaneous rupture of membranes for over 4 hours occurred in 51(32%). Vaginal delivery was recorded in 89.7%. Breast feeding was practiced by 48%.Conclusions: Breast-feeding still remains a risk factor for MTCT OF HIV Early administration of   maternal antiretroviral drugs significantly reduces the rate of mother to child transmission of HIV

Psychometric properties of a theory of planned behavior questionnaire for assessing the midwives’ intention to provide planned home birth services in Nigeria

We developed and psychometrically tested a Theory of Planned Behavior (TPB) questionnaire which focused on assessing the midwives’ intention to provide planned home birth (PHB) services. This is a quantitative, cross-sectional survey, conducted among 226 midwives working in ten participating health facilities. The reliability and validity of the theoretical constructs were assessed. The Cronbach’s alpha values were >0.8 for all scales, suggesting satisfactory internal consistency. Confirmatory factor analysis revealed sufficient convergent validity (the average variance extracted was >0.5 for each construct) and discriminant validity. The study gathered an evidence of the usefulness of TPB in the specific context of PHB

Aggressive angiomyxoma of the uterine corpus: A rare presentation

Aggressive angiomyxoma (AA) is a rare benign soft tissue tumor usually affecting the female pelvis and perineum. A 16‑year‑old girl presented on June 23, 2016, with vaginal protrusion of 1‑year duration. Examination revealed protrusion through the introitus; it was hyperemic with necrosis. Investigation revealed urinalysis that revealed blood (+), leucocytes (+), and others normal; Swab (taken from purulent discharge on the protruded mass) microscopy revealed numerous pus cells; and culture yielded no growth. Abdominopelvic ultrasound (USS) showed left‑sided pelvic soft tissue mass with no features of metastasis. Other investigations were normal. She had polypectomy with subtotal abdominal hysterectomy. Histology revealed benign AA. A rare tumor of the genital tract had been presented with a diagnostic dilemma. However, confirmation of diagnosis was easy with histology.Keywords: Angiomyxoma; uterine corpus; vaginal protrusio

Oxidative stress and outcome of antioxidant supplementation in patients with polycystic ovarian syndrome (PCOS)

Background: PCOS is a condition with significant decrease in antioxidant with an increased risk of oxidative stress. Antioxidant supplementation has been shown to improve insulin sensitivity in PCOS and may improve outcome of management of PCOS. Objectives of this study were to determine the oxidative stress level of PCOS patients, to assess the effect of antioxidant supplementation on the outcome of management of PCOS and to compare with a control group.Methods: The study was a single blind randomised control trial involving 200 patients with PCOS. The study was conducted at Usmanu Danfodiyo University Teaching Hospital Sokoto. They were randomly divided into intervention and control groups and base line serum levels of oxidative stress marker, antioxidant enzymes, vitamins and minerals were determined. Antioxidant supplementation and placebo were given to the intervention and control groups respectively. All the patients had ovulation induction with clomiphene citrate and were followed up for 6 months. Outcome measures were clinical pregnancy or menstrual regularisation. Level of significance was <0.05.Results: There was statistical significance in the serum levels of oxidative stress marker, antioxidant enzymes, vitamins and minerals between the two groups (post intervention). Glutathione peroxidase (p = 0.001), superoxide dismutase (p = 0.0001), catalase (p= 0.0369), melondialdehyde (p= 0.007), Vitamin A, Vitamin C, Vitamin E (p = 0.0001), zinc and copper (p = 0.0001). The clinical pregnancy outcomes were 22 (22%) versus 2 (2%); live births 18 (18%) versus 2 (2%) and menstrual regularisation 48 (48%) versus 46 (46%) in the intervention and control groups respectively.Conclusions: Antioxidant supplementation in this study significantly affected pregnancy rate in patients with PCOS. Larger studies are suggested to revisit the conclusion of the Cochrane review that antioxidants supplementation had no significant role in female infertility

Predictors of midwives’ intention to provide planned home birth services to low-risk women: a theory of planned behaviour approach

Objective: Planned home birth may increase women’s access to skilled midwives in all settings. Using theory to understand and predict midwives’ intention regarding planned home birth services is rare. Therefore, using the theory of planned behaviour, we determined the factors associated with midwives’ intention to provide planned home birth services to low-risk women. Design: This cross-sectional study adopted a quantitative approach and a survey. Stratified random sam- pling was used to recruit 226 midwives in Sokoto, Nigeria. Data—including descriptive statistic and mul- tiple linear regression analyses—were analysed using SPSS 23 and significant was set at 0.05. Setting: Ten public health facilities in Sokoto, northwestern Nigeria. Participants: Among all 460 midwives (women aged 20–60 years), working in the maternity wards of health facilities in Sokoto, a sample of 226 midwives was calculated using a power of 0.80 and a 95% confidence interval. Findings: The multiple linear regression analyses confirmed that the major factors associated with mid- wives’ intention to provide planned home birth services were midwives’ attitude towards planned home birth (p < .001) and midwives’ previous experience with planned home birth practice (p = .008). Conclusions and implications: The theory of planned behaviour is a useful framework for identifying fac- tors that affect midwives’ intention to provide planned home birth services. While future research may employ a qualitative approach to explore other factors, planned home birth education campaigns should target information that enhances positive attitude and encourages midwives to provide planned home birth services

Planned home birth: promoting safe home birth and midwifery model of care in Sokoto Nigeria

This book provides details on what constitutes an ideal planned home birth practice among midwives and maternity providers—during antenatal, intrapartum, and postpartum. One unique feature of this book is that we included clinical vignettes in each session to facilitate active learning and experience sharing regarding planned home birth practice among midwives. We believe that this book will be useful to midwives, maternity care providers, and educators in teaching the planned home birth practice

Pelvic organ prolapse managed at Usmanu Danfodiyo University Teaching Hospital, Sokoto: A 10-year review

Background: Pelvic organ prolapse can have a detrimental effect on woman's quality of life by limiting physical, social, psychological, and sexual functions. We determined the prevalence, predisposing factors, and complications of pelvic organ prolapse at the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. Materials and Methods: A retrospective study of the cases of pelvic organ prolapse managed at UDUTH, Sokoto, between January 1, 2003, and December 31, 2012. Results: The prevalence of pelvic organ prolapse was 1.4% of all gynecological admissions. The mean age of the patients was 45.3 ± 16.1 years. Majority of the patients, i.e., 63.7% were premenopausal. The grand multiparous women constituted 65.9% of the patients. The most common presenting symptom was a mass protruding through the vagina. The prolapsing organs included uterus 75.8%, bladder 12.1%, rectum 6.6%, and a combination of bladder and rectum 5.5%. The most common predisposing factor identified was unsupervised home delivery. Most of the patients had surgical intervention that included vaginal hysterectomy 59.3%, anterior colporrhaphy 7.7%, posterior colpoperineorrhaphy 6.6%, and combined anterior colporrhaphy and posterior colpoperineorrhaphy 5.5%. Hemorrhage was the most common intraoperative complication encountered in anemia 10.7% and wound infection 2.7% was most prevalent in the postoperative period. Conclusion: Multiparity, prolonged labor, and unsupervised deliveries were significant predisposing factors of pelvic organ prolapse antenatal care; skilled supervised deliveries and access to effective family planning methods will decrease the prevalence

Primary vaginismus: treatment with botulinum toxin

Background: Vaginismus is a rare condition. It may result in unconsummated marriages with subsequent marital disharmony. The most severe forms of these spasms of the vaginal muscles are often refractory to a variety of conventional treatment.Case Report: The index case was a 35-year old nulligravid, civil servant who presented to the gynaecological outpatient clinic with a complaint of inability to have coitus since she married 5years prior to presentation. She had several counselling sessions by both gynaecologists and psychiatrists, and had used several forms of treatment with improvement in her condition. She, subsequently, had successful treatment with intra-vaginal botulinum toxin injection.Conclusion: In cases of severe vaginismus, botulinum toxin injection can be considered as a first line option of treatment.Keywords: BotoxR, fear, penetration, spasm, vagina

Prevalence and pattern of sexual assault in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Introduction: sexual violence is an important public health problem of growing concern all over the world. This study was conducted to determine the prevalence and pattern of sexual assault managed in Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria. Methods: it was a retrospective study that looked into cases of sexual assault admitted into the hospital between January 2010 and December 2014. Information on patients’ biodata, and relevant details on the cases were extracted from the patients’ case files and analyzed. Results: out of the 5317 gynecological admissions during the period under study, 45 (0.84%) were cases of sexual assault. Of these, only 34 case files were available for data extraction. The patients’ age ranged from 2 to 37 years (mean = 12.6 + 8.3). About two thirds (61.8%) of those affected were young children (aged 12 years and below). In majority of cases (70.6%) the assault was penetrative, and in most of the cases (91.2%) only a single assailant was involved. In close to two thirds of cases, the assailant was either an acquaintance (38.2%) or a family member (20.6%). Although law enforcement agents were informed in majority (58.8%) of cases, arrests were made in less than half (41.2%). Conclusion: although the prevalence of sexual assault in this study appears to be low, a major cause for concern is the fact that those affected were predominantly young children. Parents should be more vigilant in monitoring their children’s movement, and stringent laws should be enacted and enforced to curb this heinous act.The Pan African Medical Journal 2016;2