Epidemiology of Vesico-Vaginal Fistula at the University of Ilorin Teaching Hospital, Ilorin, Nigeria

Context: Vesico-vaginal fistula (VVF) is a major public health problem in Nigeria. Objective: To describe the causes and patterns of presentation of vesico-vaginal fistula in a tertiary hospital in Central Nigeria. Subjects and Methodology: Records of all patients with VVF seen over a 10-year period (1st January, 1988 to 31st December, 1997) at the University of Ilorin Teaching Hospital were reviewed. The patients' social and demographic data, aetiological factors, anatomical types and complications of VVF were analysed. Results: There were 44 cases of VVF during the period. Obstetric VVF accounted for 37 (84.1%) of the cases. Most of the patients were illiterate 39 (88.6%), and of low social class 37 (84.1%). Most had poorly supervised deliveries; 33 (89.2%). The age of the patients ranged between 15 and 73 years with a mean age of 29.4 years. The highest frequency was in the 15-19 years age bracket (25%) and 43.2% were primiparous women. Prolonged obstructed labour (65.9%) was the commonest cause of VVF in the patients. Other causes include advanced cervical cancer 6 (13.6%), ruptured uterus 3 (6.8%), caesarean section 3 (6.8%), forceps delivery 1 (2.3%), caesarean hysterectomy 1 (2.3%) and total abdominal hysterectomy 1 (2.3%). Twelve (27.3%) patients were separated/divorced from their husbands. Of the 33 VVF patients that had VVF repair, 29(87.9%) were successful; 27 (81.8%) at the first attempt and 2 (6.1%) at the second attempt. Conclusion: Urinary fistulae are still a major health problem for women in this locality and prolonged obstructed labour is the major cause. Key Words: Vesico-Vaginal Fistula, Obstructed Labour, Urinary Incontinence [Trop J Obstet Gynaecol, 2002, 19: 101-103

Childhood Benign Surgical Gynaecological Disorders in Ilorin, Nigeria.

Context: Childhood benign gynaecological conditions are rare, yet their recogniton and correct management can have a huge impact on the individual's long-term reproductive health. Objective: To describe the experience with benign surgical gynaecological disorders in a tertiary health care institution. Study Design, Setting and Subjects: A descriptive analysis of 93 childhood benign gynaecological disorders that were surgically managed between 1st January 1989 and 31st December 1998 at the Maternity Hospital Wing of University of Ilorin Teaching Hospital, Ilorin, Nigeria. Result: Procedures to treat childhood benign gynaecological conditions accounted for 101 (2.6%) of the 3,919 gynaecological operations performed during the study period. The ages of the patients ranged from 8 months to 16 years. The three leading disorders were clitoridal cyst 26(28.0%), labial adhesion 21 (22.6%) and urethral mucosal prolapse 20 (21.5%). Others include vaginal laceration from rape 9 (9.7%), imperforate hymen 7 (7.5%), Bartholin abscess 5 (5.4%) and ovarian cysts 5 (5.4%). Conclusion: This study showed that childhood benign surgical gynaecological disorders are uncommon in our environment. Female circumcision was implicated as the aetiological factor in most of the patients suffering from the three commonest disorders. Discouraging female circumcision has the potential to significantly reduce the prevalence of paediatric gynaecological problems in Nigeria. Key Words: Paediatric Gynaecology, Congenital, Genital Tract [Trop J Obstet Gynaecol, 2003, 20: 37-39

Evaluation de l’impact du contrôle des naissances sur le taux de fécondité en Afrique subsaharéenne

Using a cross-country data drawn from 40 countries and a multiple regression analysis, this paper examines the impact of birth control devices on the rate of fertility in sub-Saharan Africa. Our a-priori expectations are that the more women used birth control devices, the less will be the fertility rate in sub-Saharan Africa. The result obtained from the study indicates that except for withdrawal method that fall contrary to our expectation other variables (methods) like the use of pills, injection, intra uterine device (IUD), condom/diaphragm and cervical cap, female sterilization and periodic abstinence/rhythm fulfilled our a-priori expectations. These results notwithstanding, the paper suggests measures, such as the need for massive enlightenment campaign on the benefit of these birth control devices, the frequent checking of the potency of the devices and good governance in the delivery of the devices (Afr J Reprod Health 2009; 13[4]:137-145).Cette étude examine l’impact des méthodes du contrôle des naissances sur le taux de fécondité en Afrique subsaharéenne à l’aide des données à travers champs recueillies dans 40 pays et d’une analyse de la régression multiple. Nos espérances a priori sont que plus les femmes emploient les méthodes du contrôle des naissances, plus le taux de fécondité en Afrique subsaharéenne baissera. Le résultat obtenu montre qu’à part la méthode du coϊt interrompu qui a baissée contrairement à ce que nous nous attendions, les autres variables (méthodes) comme l’emploi des pilules, l’infection, le dispositif intra-utérin (DIU), le préservatif, la stérilisation féminine et l’abstinence périodique/le rythme ont satisfait toutes nos espérances a priori. Malgré ces résultats, l’étude propose des mesures telles la nécessité de lancer une grande campagne de sensibilisation sur les bienfaits de ces méthodes du contrôle des naissances, la vérification fréquentes de l’efficacité des méthodes et la bonne gouvernance en matière de la prestation de ces méthodes (Afr J Reprod Health 2009; 13[4]: 137-145)

Knowledge, Attitude and Practice of Cervical Smear as a Screening Procedure for Cervical Cancer in Ilorin, Nigeria

Context: Carcinoma of the cervix is a preventable disease but it remains the most common genital cancer in African women. Objective: To determine the knowledge, attitude and practice of cervical smear as screening procedure for cervical cancer by female health workers in Ilorin, Nigeria. Study Design, Setting and Subjects: A questionnaire was designed for cross sectional survey of 483 female health rd th workers in Government hospitals in Ilorin metropolis. This was carried out between 3 September and 30 November 2001. Main Outcome Measures: Knowledge, utilization and compliance rates among various groups of female professional health workers. Results: Three hundred and thirty seven (69.8%) knew about pap smear as a screening procedure for cervical cancer while 146 (30.2%) had no such knowledge. Of those with knowledge of pap smear, only 10 (0.3%) had pap smear test at least once previously. There is significant difference in the utilization of pap smear as a screening test between Doctors, Medical Laboratory Scientists and Nurses (