Rising trend in maternal mortality at the university of Maiduguri Teaching hospital

Context: Various interventions have been introduced to reduce the very high maternal mortality ratio in our environmentbut to date the success is only marginal at best.Objective: To determine the trend in maternal mortality in University of Maiduguri Teaching Hospital (UMTH).Methods: Analysis of records of all women who died in pregnancy, labour and puerperium[up to 42 days after a pregnancy event] in UMTH between January, 2006 and December, 2010 was conducted.Results: The maternal mortality ratio (MMR) was 1074/100,000 live births. The main causes of maternal mortality were eclampsia in 34.6% of cases, haemorrhage (9.1%), HIV(17.8%) and puerperal infections (7.5%). There was rising trend in maternal mortality ratio over the study period. Factors contributing to maternal death included advanced maternal age, grand-multiparity, illiteracy, non-utilization of antenatal care services and late presentation to hospital.Conclusion: The maternal mortality ratio in UMTH is in in the upward trend and many of the causes of maternal death are avoidable. HIV appears to be an emerging major contributor to maternal deaths. There istherefore the need to strengthen the existing maternal health care services in Maiduguri, Borno state.Key words:Maternal mortality, trends, causes, Maidugur

Trends of contraceptive utilisation in aminu kano teaching hospital, Northern Nigeria

The use of contraception in Northern Nigeria and indeed among clients in Aminu Kano Teaching Hospital (AKTH), Kano is in the increase. Objective: To determine the trend in contraceptive utilization among family planning clinic attendees in AKTH. Method: A retrospective review of the records of clients, who attended family rd st planning clinic of AKTH over a 3 year period from 3 January, 2011 to 31 December, 2013 was conducted. Results: A total of 8488 women attended the family planning clinic over the study period and up to 4679 clients accepted various forms of contraceptives. The contraceptive uptake was 55.1%. About half (49.8%) of the clients were between the ages of 20-29years and grandmultiparas constituted the largest (85.9%) group. Up to 31% of the clients were civil servants. There is a statistically significant (p =0.017) rising trend in the yearly utilization of contraception from 1033(12.17%) in 2011, 1284 (15.13%) in 2012, to 2362 (27.83%) in 2013. Injectable method was the most common accounting for 56.3%, while male condom was the least (0.17%). Vasectomy was however not recorded. Irregular vaginal bleeding was the commonest side effect (29.7%) experienced by the clients. Conclusion: There is a rising trend of contraceptive utilization in AKTH Kano. Male contraceptive utilization is however, extremely low. There is therefore the need to sensitized and enlightened men to avail themselves for contraception and this will encourage their spouses to improve on the use of the available methods

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

Umbilical cord infection prevention practices among rural women attending immunization clinic in kumbotso, Kano state, Nigeria

Umbilical cord infections are more prevalent in developing countries because of the high rates of unhygienic cord care practices. Objectives: This study was undertaken to explore the various practices related to umbilical cord care among rural community women attending an immunization clinic in Kumbotso, Kano State, Nigeria. Method: A descriptive cross-sectional study design was used for the study. This study was carried out in immunization clinic at Kumbotso CHC of Kumbotso Local Government Area (LGA), Kano state Nigeria. Sample size was 265. Data was collected with interviewer administered semi-structured questionnaire and analyzed using Statistical Package for Social Science (SPSS) version 20 software. The result obtained was presented in the form of tables. Results: Majority, 200 (75.5%) of respondents' hands were gloved. In 126 (47.5%) of respondents, new razor blades were used, in 117 (44.2%) of respondents' scissors was used and the remaining 22 (8.3%) of respondents used razor blade or knife to cut the umbilical cord. Up to 159 (60%) of respondents applied mentholated spirit. One hundred and sixty-nine (63.8%) of respondents were informed of safe umbilical cord practices by health workers. Cord infection rate occurred in 53 (20.1%) babies. Conclusion: Cord infection prevention and control practices were high in this community with a relatively low cord infection rate. Even though Chlorhexidine was not used, health workers should emphasize and as well recommend its use in cord care. Community-based study is recommended to generate data about cord infections and practices inside the community

Distributions of anthropometric measurements of new born babies among various ethnic groups in Maiduguri, Nigeria: a prospective study.

Weight and other newborn anthropometric measurements at birth are considered as the most important indicators of a newborn's chances of survival, growth, long-term health and psychosocial development. Objective: To determine the mean birth weight, birth length and head circumferences of new born babies among the various ethnic groups in Maiduguri. Method: A descriptive cohort study involving 854 pregnant women with their live singleton babies was carried out in the Departments of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital (UMTH) and the State Specialist Hospital (SSH), Maiduguri, over a 6-months period, between 2 February 2009 and 29 July 2009. Mothers' socio-demographic and obstetrics performances, baby's birth weights, birth lengths and head circumferences were obtained and recorded and data analyzed using SPSS version 16. Statistical significance was computed by t-test and Chi-square. A P value <0.05 was considered significant. Results: A total of 854 mothers together with their 854 live singleton babies were studied. There were 460 (53.9%) male and 394 (46.1%) female babies. Among these babies, 144 were low birth weight, 660 had normal birth weight while high birth weight was seen in 50 babies. The mean birth weight of all babies delivered in the study population was 3030.47±631g, with mean birth length of 47.8±3.1cm, and the mean head circumference was 34.2±2. All the parameters studied were significantly lower in those that were of LBW compared to babies that were not of LBW, and the mean difference was statistically significant (P value 0.000). Conclusion: All the anthropometric measurements were highest in Igbo newborns while Hausa/Fulani had the lowest among the various ethnic group studied in Maiduguri. Improving the socio-economic status especially of the disadvantage ethnic group and further community based research is recommended.&nbsp

A 10‑year Review of the Clinical Presentation and Treatment Outcome of Asherman’s Syndrome at a Center with Limited Resources

Background: Many women suffer from some degree of intrauterine adhesions (IUAs) presenting with various clinical symptoms and signs. Hysteroscopy is the mainstay of diagnosis, classification, and treatment of the IUA. Aim: This study was undertaken to review the clinical features and treatment outcome in patients diagnosed with Asherman’s syndrome at the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, over a 10 years period, 1997–2006. Subjects and Methods: This is a retrospective study of cases of Asherman’s syndrome managed at the UMTH over a 10‑year period, from January 1, 1997 to December 31, 2006. Case records of the patients were retrieved from medical records’ Department. Sociodemographic and clinical information relating to clinical presentations, treatment modalities, and outcomes were collated. The data were analyzed using SPSS 16.0 Statistical Computer Package (SPSS Inc., IL, USA 2006). Chi‑square and binary logistic regression were used for inferential statistics. Results: Asherman’s syndrome constituted 8.1% (81/996) of all gynecological operations in UMTH during the study period. The case records retrieval rate was 96.3% (78/81 folders). Most of the patients, 59% (46/78) were in their third decade and majority 85.9% (67/78) were married. The most common risk factor was pregnancy‑associated, accounting for 61.5% (48/78). Infertility and hypomenorrhea were the most common mode of presentations in 55.1% (43/78) and 32.1% (25/78) of cases, respectively. Most of the patients 85.9% (67/78) were treated by blind dilatation and curettage (D/C), Foley’s catheter insertion and estrogen‑progesterone combination. Correction of menses was seen in 37.2% (29/78) of the patients while the pregnancy rate was 32.1% (25/78). On binary logistic regression age of the respondents, multigravidity, and previous pelvic surgeries for pregnancy (C/S and D/C for abortion) emerged as the only respondent’s related risk factors associated with the development of Asherman’s syndrome. Conclusion: Asherman’s syndrome is relatively common due to complications of pregnancy and delivery, and blind D/C has a relatively poor outcome. Age of the respondents, multigravidity, and previous pelvic surgeries for pregnancy (C/S and D/C for abortion) were associated with the development of Asherman’s syndrome. Therefore, other methods of adhesiolysis such as hysteroscopic adhesiolysis should be explored.Keywords: Asherman’s syndrome, Clinical presentation, Maiduguri, Treatment outcom

Combined uterine and urinary bladder rupture: an unusual complication of obstructed labor in a primigravida

Idris Usman Takai,1 Abdulkadir Abubakar2 1Department of Obstetrics and Gynaecology, 2Department of Surgery, Bayero University/Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria Background: Combined uterine and urinary bladder rupture following prolonged obstructed labor is indeed a momentous uro-obstetric emergency. The urinary bladder involvement is distinctly rare in the absence of factors that predispose the bladder to be adherent to the lower uterine segment and is quite unusual in a primigravida. Objective: To report a rare case of uterine rupture involving urinary bladder secondary to a prolonged obstructed labor in a primigravida from a low resource setting. Case: A 17-year-old married unbooked primigravida who presented with a 3-day history of spontaneous onset of labor at term that was initially managed at home and later in a primary health care center where she had fundal pressure and oxytocin augmentation, respectively. The labor was complicated by combined uterine and urinary bladder rupture with sepsis. She was resuscitated and had exploratory laparotomy with uterine and urinary bladder repair. The postoperative period was uneventful and she was followed-up at the gynecology and family planning clinics. Conclusion: There is a need for community reawakening on the inherent risks of teenage pregnancy, bad obstetric practices, and unsupervised pregnancy, labor, and delivery, particularly in the rural settings as in the index patient. A high index of suspicion and prompt appropriate intervention will reduce the sequel of morbidity and occasional mortality from this predicament. Keywords: uterine rupture, bladder rupture, primigravida, labo

Women’s gender preferences for their obstetrician and gynaecologist at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria

Background: There has been a reported increase in women's desires to be attended to by female obstetricians and gynaecologists during consultations.Objective: This study was conducted to find out if women have a gender preference in selecting their obstetricians and gynaecologists and the factors associated with their preferences.Methodology: A descriptive and cross-sectional hospital based study using a questionnaire administered face to face in the Department of Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital Maiduguri, Borno State, North-East Nigeria, recruiting 325 women who attended the Obstetrics and Gynaecology Out-patient Clinic over a 1-month period in 2009.Results: Two hundred and one women (67%) showed gender bias for the attending doctor with 36.7% (110) in favour of female obstetricians and gynaecologists and 30.3% (91) in favour of males, while 99 (33.0%) were indifferent to the gender. Female preference was significantly associated with age (25-34years p=0.000), ethnic group (Kanuri/Shuwa p=0.000), occupation (housewife p=0.001), marital status (married women p=0.002) and religion (Islam p=0.002). Male preference was, however, significantly associated with higher educational status (p=0.000). Women who preferred male obstetricians and gynaecologists argued several different points, that male doctors have more sympathy, experience, dedication, availability, amongst others. Those who preferred female doctors rated religion, culture and tradition as more important.Conclusion: Most of the women were gender biased for the attending obstetrician and gynaecologist, with a female preponderance. However, the present study suggests that for many women, their preferences were not based on gender alone, but also religious, cultural and traditional beliefs of the community