Nigeria, a high burden state of obstetric fistula: a contextual analysis of key drivers

Obstetric fistula (OF) remain a source of public health concern and one of the most devastating maternal morbidities afflicting about two million women, mostly in developing countries. It is still prevalent in Nigeria due to the existence of socio-cultural beliefs/practices, socio-economic state and poor health facilities. The country's estimated annual 40,000 pregnancy-related deaths account for about 14% of the global maternal mortality, placing it among the top 10 most dangerous countries in the world for a woman to give birth. However, maternal morbidities including OF account for 20 to 30 times the number of maternal mortalities. This review substantiates why OF is yet to be eliminated in Nigeria as one of the countries with the largest burden of obstetric fistula. There is need for coordinated response to prevent and eliminate this morbidity via political commitment, implementation of evidence-based policy and execution of prevention programs

Hierarchical modelling of factors associated with the practice and perpetuation of female genital mutilation in the next generation of women in Africa

Despite a total prohibition on the practice of female genital mutilation (FGM), young girls continue to be victims in some African countries. There is a paucity of data on the effect of FGM practice in two generations in Africa. This study assessed the current practice of daughters’ FGM among women living in 14 FGM-prone countries in Africa as a proxy to assess the future burden of FGM in the continent. We used Demographic and Health Surveys data collected between 2010 and 2018 from 14 African countries. We analyzed information on 93,063 women-daughter pair (Level 1) from 8,396 communities (Level 2) from the 14 countries (Level 3). We fitted hierarchical multivariable binomial logistic regression models using the MLWin 3.03 module in Stata version 16 at p<0.05. The overall prevalence of FGM among mothers and their daughters was 60.0% and 21.7%, respectively, corresponding to 63.8% reduction in the mother-daughter ratio of FGM. The prevalence of FGM among daughters in Togo and Tanzania were less than one per cent, 48.6% in Guinea, with the highest prevalence of 78.3% found in Mali. The percentage reduction in mother-daughter FGM ratio was highest in Tanzania (96.7%) and Togo (94.2%), compared with 10.0% in Niger, 15.0% in Nigeria and 15.9% in Mali. Prevalence of daughters’ FGM among women with and without FGM was 34.0% and 3.1% respectively. The risk of mothers having FGM for their daughters was significantly associated with maternal age, educational status, religion, household wealth quintiles, place of residence, community unemployment and community poverty. The country and community where the women lived explained about 57% and 42% of the total variation in FGM procurement for daughters. Procurement of FGM for the daughters of the present generation of mothers in Africa is common, mainly, among those from low social, poorer, rural and less educated women. We advocate for more context-specific studies to fully assess the role of each of the identified risk factors and design sustainable intervention towards the elimination of FGM in Africa.Publisher PDFPeer reviewe

Outcomes of surgical treatments for acquired gynatresia in a tertiary institution in Ibadan, Nigeria

A 16-year review of causes, clinical presentation and management outcomes of Acquired gynatresia (AG) at University College Hospital, Ibadan, Nigeria. Information was obtained using a proforma and data analysed using SPSS version 20.0. The mean age of the 31 women with AG was 35.6 ± 6.2 years. The majority (90.3%) were married and had a tertiary level of education. The mean parity was 0.74 ± 1.1 and 54.8% were nulliparous while 29.0% were primiparous women. The commonest cause of AG was the insertion of caustic substances into the vagina and this was mainly for the treatment of uterine fibroid (68.2%) and infertility (54.5%). Over three-quarters presented with dyspareunia while 54.8% had infertility. A majority (87.1%) had one-stage surgery with dissection/excision of fibrotic tissue being the commonest (45.2%) and sigmoid vaginoplasty the least performed. Postoperative complications were seen in 29.0% of cases. Acquired gynatresia remains a condition of public health interest despite an increase in female education and relatively improved health care in Nigeria.Impact statement What is already known on this subject? Acquired gynatresia (AG) could be of chemical and non-chemical origin and result from certain cultural beliefs and practices. What do the results of this study add? Irrespective of the women’s level of education, there is inadequate awareness of the implications of inserting caustic materials into the vagina. However, there is a high success rate of treatment of AG. What the implications are of these findings for clinical practice and/or further research? There is a need to increase health education and awareness of the populace on the causes of AG and its associated complications

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tween phases. Women experienced 350 ml of median blood loss after study entry in the pre-intervention and 50 ml in the NASG phase (p ! 0.0001). Mortality decreased from 18% preintervention to 6% in the NASG phase (RR = 0.31, 95% CI 0.15-0.64, p = 0.0007). In a multiple logistic regression model, the NASG was associated with reduced mortality (odds ratio 0.30; 95% CI 0. 13-0.68, p = 0.004). Conclusion: The NASG shows promise for reducing mortality from PPH in referral facilities in Nigeria