Malaria in Pregnancy: Morbidities and Management

Malaria infection during pregnancy remains an important public health concern especially in the tropics with substantial risk for the mother, her fetus and the neonate. More than 25 million African women in malaria endemic areas get pregnant and are at risk of infection with Plasmodium falciparum. Several pregnancy complications including miscarriage, preterm labor, intrauterine growth restriction (IUGR) and intrauterine fetal death (IUFD) have been associated with malaria. In early pregnancy treatment options are very limited partly due to drug resistance and the uncertainty about the safety of some antimalarials in pregnancy. Quinine still remains safe in all trimesters. A package of interventions for the prevention andcontrol of malaria in the African Subregion during pregnancy has been recommended by the World Health Organization (WHO). These include intermittent preventive treatment (IPT), use of insecticide treated nets(ITNs) and access to effective case management for malaria illness and anemia.Keywords: malaria in pregnancy, treatment, insecticide treated nets,  intermittent preventive therapy

Comparing the outcomes of labour induction with misoprostol and dinoprostone at Amino Kano teaching Hospital Kano Norhtwest Nigeria

Context: Induction of labour is an old procedure performed to artificially terminate pregnancy for various indications in the interest of the mother, the fetus or both. The aim is to achieve vaginal delivery. Various methods have been in use which include the use of Misoprostol, Dinoprostone, oxytocin infusion and others. In an effort to determine which agent gives better outcome studies were carried out comparing the agents with one another.Objectives: To compare the outcomes of labour induced with Misoprostol and Dinoprostone and to determine the incidence of induction of labour at Aminu Kano Teaching Hospital Kano Nigeria.Materials and Methods: The study was restrospective involving a total of 364 patients admitted for labour induction between January 2005 to December 2009. Out of this 274 were induced with Misoprostol and 90 were induced with Dinoprostone.Results: The incidence of labour induction is 2.35%. The indications include postdatism, Hypertensive disorders of pregnancy, PROM, IUFD and others such as Sickle cell disease, and Diabetes Mellitus. The most common indication was postdatism 45.9%. The success rate was 83.9% for Misoprostol and 82.2% for Dinoprostone. There is a statistically significant difference in terms of shorter induction delivery interval in favour of Misoprostol. There were less number of babies with APGAR score less than 6 in the Misoprostol group. There is no statistically significant difference in terms of the spontaneous vaginal deliveries and caesarean section rates between the two groups.Conclusion: The rate of induction of labour in the centre is 2.35%. Misoprostol was found to be a more efficient and safer agent for induction of labour if the procedure is well managed. It was associated with shorter induction delivery interval without compromising the fetomaternal outcome compared to Dinoprostone.Keywords: Induction of Labour, Misoprostol, Dinoprostone, OutcomeTrop J Obstet Gynaecol, 30 (1), April 201

Job satisfaction among resident doctors in a tertiary healthcare facility in Northern Nigeria, a cross sectional

Background: Over the past few years the number of doctors choosing to work abroad or in non-medical professions has been growing. Among those doctors who have remained in the workforce, there is a similar dissatisfaction, reflected in part by a general strike in 2010 by Nigerian doctors especially Association of Resident Doctors (ARD) in favour of higher wages and better working conditions. Job demands and workload of hospital doctors are increasing.The aim of this paper is to assess job satisfaction among junior and senior resident doctors of different specialties in Aminu Kano Teaching Hospital (AKTH) and to compare the level of satisfaction between these two groups of professionals with the purpose of making recommendation for improvement to health human resource managers.Method: This was a cross- sectional study that involved 150 resident doctors of different cadre and specialization between 1st December, 2011 and 28th January, 2012. The questionnaire was used to assess the socio-demographic information of the respondents, job satisfaction and work related conditions.Result: Most of the doctors (41.3%) were aged 31-35 years. The mean age of junior residents was 32.6±3.7 years, while that of senior residents were 35±4 years. This differences was not statistically significant (p=0.094).Most resident doctors (64.2%) worked for 7-9hours daily. All doctors worked for average duration of 9.4±2.6 hours. Junior residents worked for mean duration of 9±2.3 hours while senior residents worked for 9.1±3.2 hours. This was not statistically significant p=0.075. Most of the resident doctors (56.7%) had been in the service of the hospital for 1-3 years. The mean duration of service was 3.5±2.1. Most of the doctors (78%) had 7-9 dependents. The average number of dependents for junior residents was 4±3, while for senior residents was 6±2 and this was statistically significant (p=0.03). The mean number of dependents was 5±3. Most doctors (60%) had their last promotion less 1 year prior to the study with mean of 0.9±0.9years.80.1% of doctors were satisfied with their job, 17.3% were undecided and 5.2% were dissatisfied. More senior residents (82.2%) felt satisfied with their jobs than junior residents (77.9%) and this was statistically significant, p=0.035.Job satisfaction among doctors was more among those who were aged 41-45(100%) but there was a very weak positive correlation (r=0.21) between age and job satisfaction. Job satisfaction was more in those who have worked for at least 4 years with a weak positive coefficient of correlation (r=0.28).Length of service correlates more with job satisfaction than any other factors among doctors.Job satisfaction was highest among resident doctors in chemical pathology and radiology and lowest among resident doctors in obstetrics and gynaecology.Increase in manpower employment by management so as to reduce work hour per day may improve satisfaction among obstetrics and gynaecology residents.Conclusion: Job satisfaction among the doctors in this study was higher when compared with other studies within Nigeria and other developing countries. However, Job satisfaction may increase if physicians experienced more opportunities to advance their careers, team spirit, and better supervision.Keywords: Job Satisfaction, Dissatisfaction, Resident Doctors, Tertiary Healthcare, Northern Nigeria, Cross Sectional SurveyTrop J Obstet Gynaecol, 30 (1), April 201

Gynecological malignancies in Aminu Kano Teaching Hospital Kano: A 3 year review

Objective: To study the pattern of gynecological malignancies in Aminu Kano Teaching Hospital.Materials and Methods: This was a retrospective observational study carried out in the Gynecology Department of Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria between October 2008 and September 2011. Casenotes of all patients seen with gynecological cancers were studied to determine the pattern, age and parity distribution.Results: A total of 2339 women were seen during the study period, while 249 were found to have gynecological malignancy. Therefore the proportion of gynecological malignancies was 10.7%. Out of the 249 patients with gynecological malignancies, most (48.6%) had cervical cancer, followed by ovarian cancer (30.5%), endometrial cancer (11.25%) and the least was choriocarcinoma (9.24%). The mean age for cervical carcinoma patients (46.25 ± 4.99 years) was higher than that of choriocarcinoma (29 ± 14.5 years) but lower than ovarian (57 ± 4.5years)and endometrial (62.4 ± 8.3 years) cancers. However, the mean parity for cervical cancer (7.0 ± 3) was higher than those of ovarian cancer (3 ± 3), choriocarcinoma (3.5 ± 4) and endometrial cancer (4 ± 3). The mean age at menarche for women with cervical cancer (14.5 ± 0.71 years) was lower than for those with choriocarcinoma (15 ± 0 years), ovarian (15.5 ± 2.1 years) and endometrial (16 ± 0 years) cancers. There was one case of vulva cancer and none with vaginal cancer.Conclusion: Cervical cancer was the most frequent malignant tumor and the least was choriocarcinoma. Estimates of this important public health problem need to be addressed in various regions of Nigeria.Key words: Cancers, gynecological, nigeria, north-west, pattern, tertiary hospita

Surgical management of uterine fibroids at Aminu Kano teaching hospital, Kano, Nigeria: a 5 year review

Background: Uterine fibroids are the most common pelvic tumors. They account for a significant number of gynecological consultations. Prevalence, presentation and outcome of treatment vary in different communities.Objectives: To determine the prevalence and clinical presentation of uterine fibroids, and the morbidity associated with surgical management of uterine fibroids at Aminu Kano Teaching Hospital, Kano.Study design: Retrospective study of all the cases of uterine fibroids that were surgically managed in Aminu Kano Teaching Hospital, Kano between 1st January 2006 and 31st December 2010.Results: The period prevalence of uterine fibroids found in this study was 3.1%, 8.3% of gynecological operations were for fibroids. Main presentations were menstrual irregularities 75.9%, abdominal swelling 51.9%, lower abdominal pain 46.5%, dysmenorrhea 29.1%, infertility 20.3%. The postoperative complication of anemia occurred in 34.1% of patients who had myomectomy and 14.6% of those who had hysterectomy. Anemia was 3 times more likely to occur with myomectomy (OR 3.02, CI 1.69-3.56, P <0.05). Pyrexia occurred in 31.2% of patients who had myomectomy and 12.4% of those who had hysterectomy. It was 3 times more likely to occur following myomectomy than hysterectomy (OR 3.21, CI 1.74-5.93, P <0.05).Wound infection occurred in 13.8% and 12.4% of patients who had myomectomy and hysterectomy respectively, UTI in 6.5% and 5.6% of patients who had myomectomy and hysterectomy . They both showed no significant statistical difference between myomectomy and hysterectomy (for wound infection OR 1.13, CI 0.56-2.29, P >0.05 and for UTI OR 1.17, CI 0.42-3.23, P >0.05).Conclusion: The prevalence and presentation of uterine fibroids found in this study is similar to the finding of other studies from Northern Nigeria. The most common presentations were menorrhagia and lower abdominal swelling, and not infertility. Myomectomy was associated with higher complication rates compared to hysterectomy.Key words: Uterine fibroids, prevalence, presentation, postoperative morbidity

Free maternity services in Kano State impact of free maternity services in Kano State Nigeria

Background: Comprehensive prenatal care, impacts positively on both maternal and perinatal outcome. The free maternity policy increased access to antenatal care and a reduction in maternal mortality in secondary health facilities. The uptake of the services continues to increase at exponential rate in all the facilities across Kano State.Study design/subject: This was a cross sectional study over a period of six months(January to June 2008).The study review the components of all the services offered and the financial implication involved. The providers wereinterviewed together with patients with pre-tested questionnaire to collect information on their perception, problem and satisfaction of the services since its inception in the State in 2001.Main outcome: Utilization of maternity services by the respondents.Results: The main components of the free maternity services are: free stationeries (cards), delivery pack, free treatment of surgical or medical complication of pregnancy, Vesico-vaginal fistula and recto-vaginalfistula.(VVF/RVF) repair and screening of blood. The providers were happy with the programme, but it increased their workload especially from the neighboring states like Jigawa, Katsina and Bauchi, despite reduction in maternal morbidity and mortality (from 2700/100,000 to 950/100,000livebirths). The patients were aware of antenatal/maternity services in the General hospitals across the state, but they now spend longer time in the hospital before being attended to.Conclusion: Improvement of staffing, community participation, increase funding, and introduction of similar services in the neighboring states will improve the quality of care provided and reduce the patient load.Keywords: free maternity, Kano, orthodox facilit

Ruptured tubal molar pregnancy

Molar pregnancies in most instances develop within the uterine cavity, but may occur at any site. Ectopic molar pregnancy is a rare event. The objective of this study was to present a case of ruptured tubal molar gestation, discuss its clinical features and ways to improve diagnostic accuracy. A 35.year.old woman presented with features suggestive of ruptured tubal ectopic pregnancy. There was neither any evidence at the time of presentation to suspect a molar gestation, nor ƒÀ human chorionic gonadotrophin (ƒÀhCG) hormone estimation was done, but only a clearview pregnancy test was carried out. She had total left salpingectomy and histological evaluation of the specimen revealed complete hydatidiform mole. The hCG level normalized within 3 weeks of follow.up. Clinical features of ectopic molar pregnancy may be indistinguishable from non.molar ectopic pregnancy. We recommend ƒÀhCG estimation as well as histological examination of the surgical specimen for all patients coming with features suggestive of ectopic pregnancy

Surgical management of uterine fibroids at Aminu Kano teaching hospital, Kano, Nigeria: a 5 year review

Background: Uterine fibroids are the most common pelvic tumors. They account for a significant number of gynecological consultations. Prevalence, presentation and outcome of treatment vary in different communities.Objectives: To determine the prevalence and clinical presentation of uterine fibroids, and the morbidity associated with surgical management of uterine fibroids at Aminu Kano Teaching Hospital, Kano.Study design: Retrospective study of all the cases of uterine fibroids that were surgically managed in Aminu Kano Teaching Hospital, Kano between 1st January 2006 and 31st December 2010.Results: The period prevalence of uterine fibroids found in this study was 3.1%, 8.3% of gynecological operations were for fibroids. Main presentations were menstrual irregularities 75.9%, abdominal swelling 51.9%, lower abdominal pain 46.5%, dysmenorrhea 29.1%, infertility 20.3%. The postoperative complication of anemia occurred in 34.1% of patients who had myomectomy and 14.6% of those who had hysterectomy. Anemia was 3 times more likely to occur with myomectomy (OR 3.02, CI 1.69-3.56, P <0.05). Pyrexia occurred in 31.2% of patients who had myomectomy and 12.4% of those who had hysterectomy. It was 3 times more likely to occur following myomectomy than hysterectomy (OR 3.21, CI 1.74-5.93, P <0.05).Woundinfection occurred in 13.8% and 12.4% of patients who had myomectomy and hysterectomy respectively, UTI in 6.5% and 5.6% of patients who had myomectomy and hysterectomy . They both showed no significant statistical difference between myomectomy and hysterectomy (for wound infection OR 1.13, CI 0.56-2.29, P >0.05 and for UTI OR 1.17, CI 0.42-3.23, P >0.05).Conclusion: The prevalence and presentation of uterine fibroids found in this study is similar to the finding of other studies from Northern Nigeria. The most common presentations were menorrhagia and lower abdominal swelling, and not infertility. Myomectomy was associated with higher complication rates compared to hysterectomy.Key words: Uterine fibroids, prevalence, presentation, postoperative morbidity

Sero-prevalence of Hepatitis B Virus Infection and its Risk factors among Pregnant Women Attending Antenatal Clinic at Aminu Kano Teaching Hospital, Kano, Nigeria

Background: Pregnant women infected with hepatitis B virus (HBV) can transmit the infection to their fetuses and newborns. Neonates who contract the HBV have about 90% risk of developing chronic HBsAg carriage (HBsAg: hepatitis B surface antigen) and chronic liver disease. Neonatal immunization interrupts this vertical and perinatal transmission.Objectives: To determine the seroprevalence of HBsAg among pregnant women attending the antenatal clinic at Aminu Kano Teaching Hospital (AKTH) and to identify potential risk factors associated with HBV infection.Materials and Methods: A case control study was conducted involving a total of 303 pregnant women attending the antenatal clinic at AKTH and 303 nonpregnant women of childbearing age. Blood sample was collected from each woman and the serum tested for the presence of HBsAg using latex rapid agglutination slide test kit (Cal-Tech Diagnostic Inc., USA) in the laboratory of the hospital. Reactive samples were stored at -20ºC and further confirmed for HBsAg using enzyme-linked immunosorbent assay (ELISA) kits (Bio-Rad, France). HBsAg-positive samples were tested for hepatitis B e antigen (HBeAg) using ELISA kits (Orgenics, Israel). A pretested, structured questionnaire was used for the collection of sociodemographic data and possible risk factors. Results: The prevalence of HBsAg among pregnant women and nonpregnant women were 7.9 and 7.6%, respectively. There was no statistically significant difference in the prevalence of HBsAg in pregnant and nonpregnant women. The presence of HBeAg was statistically significant among both pregnant and nonpregnant women who tested positive for HBsAg. The risk factors associated with HBV infection were blood transfusion, ear piercing, history of an affected sibling with HBV infection, tattooing, and abortion among pregnant women.Conclusion: The prevalence of HBsAg in this study was not statistically different in pregnant and nonpregnant women. There was a high level of HBeAg infection among pregnant women who tested positive for HBsAg. History of an affected sibling with HBV infection, tattoo, and abortion were significant risk factors for HBV infection. Keywords: Africa, hepatitis B, pregnancy, risk factor

An Audit of Gynaecological Procedures Performed at Aminu Kano Teaching Hospital, Kano

Background: Audit of all gynecological procedures as one of the commonest operations performed in medical practice is not routinely done in developing countries, including Nigeria. Aim: The study was aimed at determining the rate of all gynecological procedures performed; the common gynecological procedures and their indications, and the cadre of surgeons that performed different gynecological procedures within the period under review.Materials and Methods: A 1‑year retrospective chart analysis of all gynecological procedures performed at Aminu Kano Teaching Hospital (AKTH) between 01/10/2012 and 30/09/2013 was conducted. Patients with complete relevant information in the registers were included in the audit and those with incomplete data were excluded. Data was further cleaned and analyzed using Microsoft Excel for Mac 2011, for frequencies and percentages. Results were presented by simple statistical tables.Results: A total of 6,604 patients were gynecological attendees, out of which 646 patients had gynecological procedures performed, giving an institutional gynecological procedure rate of 9.8% (646/6,604), within the period under review. Emergency gynecological procedures accounted for 5.9% (38/646), while the elective cases accounted 4.0% (26/646). Majority of the gynecological procedures was among the 20–40 years age group. About 20 different types of gynecological procedures were done and manual vacuum aspiration (MVA), for incomplete miscarriage accounted for 58.8% (380/646), while excision of transverse vaginal septum was the least at 0.3% (2/646) of all the gynecological procedures. Interns, registrars, senior registrars, and consultants were involved in performing the different gynecological procedures. Between 69 and 100% (446/646‑646/646) of some of the major gynecological procedures were carried out by consultants, 14–27% (90/646‑174/646) by senior residents (SRs), while the junior residents and interns performed only MVAs among the gynecological procedures at 53.1% (343/646) and 7.3% (47/646), respectively. Conclusion: The common gynecological procedure performed in AKTH is MVA by all cadres of surgeons, and consultants performed the highest number of all the gynecological procedures except MVA. A more regular audit of services rendered by the department is advocated. This may help to identify the gaps in training and services.KEY WORDS: Aminu Kano teaching hospital, audit, gynecological procedures, Kan