Grandmultiparity: experience at Awka, Nigeria

Background/Aim: The grandmultiparae have basically been regarded as high risk obstetric patients. This study was undertaken to estimate the prevalence in this area as well as evaluate the problems, associated factors and ways of reducing the burden. Methodology: This was a retrospective study of the problems of grandmultiparity (five or more previous viable babies) at Amaku General Hospital, Awka over a three year period, January 2006 to December 2008. One hundred and thirty five (135) grandmultiparous women (study group) were matched with a similar number of women of lower parity (Para 2 and 3), who attended and delivered in the hospital during the same period. The problems seen in both groups during pregnancy and labour, mode of delivery, birth weight, perinatal and maternal mortalities were compared. The soccio-demographic characteristics were also compared. Results: The incidence of grandmultiparae was 7.53%. Twenty nine (21.5%) of the grandmultiparae were unbooked compared to 6(4.4%) of the control group. Ninety four (69.7%) of the study group belonged to the low social class IV and V compared to 27(20%) of the control. Anaemia in pregnancy was commoner in study than in the control group (49(36.3%) versus 12 (8.9%). There was a high caesarean section rate in the study group compared to the control (31(23.0%) versus 6(4.4%). The maternal mortality rate in the study group was 22.2/1000. There was no maternal death in the control. Conclusion: Improving the socio-economic standard of our women and increased awareness in the importance of family planning will reduce the incidence and complications of grandmultiparity.Key Words: grandmultiparity, anaemia, caesarean section, family planning

Prevalence, Clinical Pattern and Major Causes of Male Infertility in Nnewi, South East Nigeria: A Five YearReview

BACKGROUND: Infertility is a major cause of marital disharmony in Nigeria because of the high premium placed on child bearing. Unfortunately, the blame is on the woman most times. OBJECTIVES: To determine the prevalence, clinical pattern and major causes of infertility based on the clinical and laboratory findings of both partners. METHODOLOGY: This is a descriptive retrospective study of 268 infertility cases that presented at Nnamdi Azikiwe University Teaching Hospital, Nnewi over a five-year period, between January 1, 2005 and December 31, 2009. RESULTS: Of the 1449 patients that presented at the gynaecology clinic, 268 came because of infertility giving a prevalence of 18.5%. The mean age was 39.1±6.0 years .The majority ( 68% )stopped formal education at the secondary level. Seventy-two percent were employed as unskilled workers. 13% admitted the history of alcohol intake while none took tobacco. The mean duration of infertility was 5 years. The more frequent type of infertility was secondary infertility (59%). The leading cause of male infertility was oligospermia. Male factor infertility alone accounted for 52 (25%)of the cases. CONCLUSION: Contribution of male factor to infertility is high. There is a need for public education on the contribution of male factor to infertility. Keywords: Prevalence, clinical pattern, male infertility, Nigeri

Pain Relief in Postabortion Care Practiced by Healthcare Professionals in South Eastern Nigeria

Background: Postabortion care (PAC) is aimed at reducing maternal morbidity and mortality resulting from the incomplete abortion and abortion complications. The use of analgesia is an integral part of high quality PAC. Knowledge of the pattern of use of analgesia in PAC by healthcare professionals would help in planning group specific training programs for more effective PAC. Aim: This study is aimed at assessing the use of analgesia in PAC among healthcare professionals in South Eastern Nigeria.Subjects and Methods: This is a cross‑sectional questionnaire‑based survey carried out among healthcare professionals in Anambra State, Nigeria between June 1 and September 30, 2006.  Participants were chosen using a multistage sampling technique. Pretested questionnaires assessing the practice of postabortion counseling were then administered. The data were analyzed using SPSSversion 20.0 software. Frequencies were within 95% confidence limits.Results: A total of 437 health professionals were included in the study. The mean age was 38.2 (10.4) years. Formal PAC training influenced the use of analgesia positively (P < 0.001). The use of analgesia in PAC was also significantly higher among professionals working in tertiary healthcare center and private specialist hospitals when compared with other facilities (P = 0.02). In general complications were more when analgesia was not employed. Older professionals were more likely to employ pain relief in PAC (P = 0.01). Furthermore, doctors were significantly more likely to employ pain relief in PAC when compared to nurses (P = 0.001).Conclusion: This study revealed a low level of use of analgesia in PAC among the healthcare  professionals. It also demonstrated a significant association between formal PAC training and use ofanalgesia in PAC. It is, therefore, recommended that increased PAC training and re‑training activities with emphasis on the need for analgesia should be conducted for healthcare professionals to improve the quality of PAC received by clients.KEY WORDS: Pain relief, post abortion care, Nigeri

Still too far to walk: Literature review of the determinants of delivery service use

BACKGROUND: Skilled attendance at childbirth is crucial for decreasing maternal and neonatal mortality, yet many women in low- and middle-income countries deliver outside of health facilities, without skilled help. The main conceptual framework in this field implicitly looks at home births with complications. We expand this to include "preventive" facility delivery for uncomplicated childbirth, and review the kinds of determinants studied in the literature, their hypothesized mechanisms of action and the typical findings, as well as methodological difficulties encountered. METHODS: We searched PubMed and Ovid databases for reviews and ascertained relevant articles from these and other sources. Twenty determinants identified were grouped under four themes: (1) sociocultural factors, (2) perceived benefit/need of skilled attendance, (3) economic accessibility and (4) physical accessibility. RESULTS: There is ample evidence that higher maternal age, education and household wealth and lower parity increase use, as does urban residence. Facility use in the previous delivery and antenatal care use are also highly predictive of health facility use for the index delivery, though this may be due to confounding by service availability and other factors. Obstetric complications also increase use but are rarely studied. Quality of care is judged to be essential in qualitative studies but is not easily measured in surveys, or without linking facility records with women. Distance to health facilities decreases use, but is also difficult to determine. Challenges in comparing results between studies include differences in methods, context-specificity and the substantial overlap between complex variables. CONCLUSION: Studies of the determinants of skilled attendance concentrate on sociocultural and economic accessibility variables and neglect variables of perceived benefit/need and physical accessibility. To draw valid conclusions, it is important to consider as many influential factors as possible in any analysis of delivery service use. The increasing availability of georeferenced data provides the opportunity to link health facility data with large-scale household data, enabling researchers to explore the influences of distance and service quality

Caesarean section in a Secondary Health Hospital in Awka, Nigeria

Setting: Amaku General Hospital, Awka is a state government owned secondary health facility in South East Nigeria.Objectives: To determine the rate, indications, outcome and complications of caesarean sections with a view to improving on our service delivery.Patients and Methods: A retrospective review of all caesarean deliveries over a five year period, January 2005 to December 2009.Results: A total of 291 caesarean sections were performed. A total of 2809 patients were delivered giving a caesarean section rate of 10.4%. The incidence was commoner in the multigravidae. The commonest indication and morbidity were cephalopelvic disproportion 72(25.6%) and wound sepsis 40 (33.3%) respectively. There was a gradual yearly increase in rate from 9.0% in 2005 to 11.4% in 2009. Maternal mortality rate was 480per 100,000 deliveries while the perinatal mortality rate was 63.8 per 1000 total births.Conclusions: The rate of caesarean section has shown a gradual yearly increase. There is need to improve on the facilities and manpower in the secondary health care facilities as these will impact positively on the quality and safety of its services.Niger Med J. Vol. 50, No. 3, July – Sept., 2009: 64 – 67.Key words: caesarean section, rates, secondary health centr

Missing intrauterine contraceptive device amongst clients in Enugu, Nigeria

Background Missing intrauterine contraceptive device (IUCD) is a known complication of IUCD use. Objective To examine the methods of diagnosis and Management modalities of missing IUCD at the University of Nigeria Teaching Hospital, Enugu. Materials and Method This was a retrospective review of the records of all clients who presented with complaints of missing IUCD over an 11 year period, from 1 st January 1990 to 31 st December 2000. Relevant information on biodata, methods of diagnosis and removal were extracted and analysed using tabulations and simple percentages. Results A total of 44,975 clients were seen at the family planning clinic within the period under review. Twenty two thousand, one hundred and sixty eight clients used IUCD, giving a 55.96% of total contraceptive use. Of these, 20 IUCD missed, giving the incidence of missing IUCD as 0.08%. The mean age of clients with missing IUCD was 38±2.18 years and the mean parity was 6.00 ± 0.54. Majority (30%) were asymptomatic. Twenty five percent presented with lower abdominal pain. One client had a co-existing pregnancy of about 10 weeks. The commonest mode of diagnosing missing IUCD was the use of plain abdominal x-ray with a marker in-utero (50%) and retrieval hook was used for removal in 45% of the cases. Three patients had exploratory laparotomy for removal of the missing IUCD. Conclusion IUCD is a method of contraception most commonly used in UNTH, Enugu. Plain abdominal x-ray with a marker in-utero is a simple and reliable diagnostic technique for missing IUCD