Predictors of Female Health Care Providers’ Knowledge on Symptoms and Risk Factors of Ovarian Cancer: A Tertiary Health Care Institutional Based Cross-sectional Study

Context: Ovarian cancer is responsible for more deaths per year than all other gynaecological cancers combined, and its overall mortality is high because of late presentation. Aims: To evaluate the predictors of knowledge of the symptoms and the risk factors of ovarian cancer among female healthcare providers in Enugu, Nigeria. Settings and Design: Cross‑sectional survey conducted at the University of Nigeria Teaching Hospital (UNTH), Enugu from June to August 2018. Subjects and Methods: A self‑administered, structured questionnaire on symptoms and risk factors of ovarian cancer was given to 422 randomly selected female healthcare providers working at UNTH. Statistical Analysis: Data were analysed using SPSS version 22.0 for  Windows (Chicago, IL, USA). Predictors of knowledge level were determined using logistic regression. P < 0.05 was considered statistically significant. Results: Mean age of the respondents was 39.22 ± 7.89 years. Less than 50% of participants know the other symptoms of ovarian cancer outside increased abdominal size (n = 268, [63.5%]). Also, <50% of participants know the other risk factors of ovarian cancer outside family history of cancer (n = 288, [68.2%]) and genetic predisposition (n = 251, [59.5%]). Female doctors are less likely not to know about the symptoms (odds ratio [OR] = 0.011, 95% confidence interval [CI] = 0.004–0.024, P < 0.001) and risk factors (OR = 0.005, 95% CI = 0.002–0.013, P < 0.001) of ovarian cancer. Conclusions: Female healthcare providers had a reduced level of awareness of the risk factors and symptoms of ovarian cancer, while  female doctors are less likely not to know about the symptoms and the risk factors. Keywords: Female health care workers, knowledge, ovarian cancer, predictors, risk factors, symptom

Evidence for decreasing sperm count in African population from 1965 to 2015

Purpose: This meta-analysis, following our previous reports those documented an overall 57% diminution in mean sperm concentration around the globe over past 35 years and 32.5% decline in past 50 years in European population, attempts to report the declining trend of sperm concentrations in African population between 1965 and 2015.Methods: In the course of retrieval of data following MOOSE guidelines and PRISMA checklist, we found a total of fourteen studies that have been conducted during that period on altering sperm concentration in the African male.Results: Following analysis of the data, a time-dependent decline of sperm concentration (r = -0.597, p = 0.02) and an overall 72.6% decrease in mean sperm concentration was noted in the past 50 years. The major matter of concern is the present mean concentration (20.38×106/ml) is very near to WHO cut-off value of 2010 of 15×106/ml. Several epidemic diseases, genital tract infection, pesticides and heavy metal toxicity, regular consumption of tobacco and alcohol are reported as predominant causative factors.Conclusion: This comprehensive, evidence-based meta-analysis and systematic review concisely presents the evidence of decreased sperm concentration in the African male over past 50 years with possible causative factors to serve the scientific research zone related to male reproductive health.Keywords: Semen quality, sperm concentration, sperm coun

Gynaecological bacterial infections: the physical and psychosocial consequences and challenges of management in resource-limited settings

Gynecological bacterial infections (GBIs) are prevalent in our environment and as a result pose a number of physical, social and psychological consequences. These infections are acquired through several ways. Treating GBIs is a daunting task making its control the most important strategy to alleviating its physical and psychosocial consequences. To highlight the physical, social, and psychological consequences of gynaecological bacterial infections in our resource limited setting. To highlight the hugely unresolved challenges associated with the management of gynecological bacterial infections in our resource-limited setting. Several databases (Medline, Google Scholar, Pubmed, WHO’s Hinari and Wikipedia) and some selected websites were searched using the following keywords: gynecological infections, vaginal infections and discharges, vaginal flora, sexually transmitted infections, pelvic inflammatory disease, syndromic management and challenges, psychosocial consequences, alternative medicine. A total of 5470 relevant articles were obtained between 1947 and 2018. Out of these only 256 relevant articles on the topic were reviewed. However, 213 were dropped for having an incomplete submission. Forty-three (43) articles were fully accessed and referenced. The high prevalence of GBIs poses a lot of burden on the reproductive and socio-economic lives of our women. This should be matched by behavioral changes, prompt diagnosis and early treatment; facilitated by accessible and affordable health care through improved government funding

A Re-Evaluation of Ectopic Pregnancies in a Resource-Limited Setting: A Ten Year Review

Context: Ectopic pregnancy (EP) is a severe challenge in contemporary gynaecology, particularly in developing economies. Late  presentation and diagnosis increase the associated morbidity and mortality. With the worldwide surge in incidence and varied presentation patterns, re-evaluation has become necessary. This study, therefore, aims at re-evaluating the risk factors and clinical patterns of EP cases in a tertiary health facility in a resource-limited setting. Settings/Methods/Statistical Analysis: All EP cases managed at the Teaching Hospital of the University of Nigeria (UNTH), Enugu,  Nigeria, from January 1, 2008, to December 31, 2017, were retrospectively evaluated. The collected data was analyzed with the 23.0 edition of Statistical Package for the Social Sciences. Descriptive statistics was done for the qualitative variables. Cross-tabulation was done; the association levels were determined by Chi-square/Fisher’s exact test and Student’s t-test for the qualitative and quantitative variables. P = 0.05 was considered as the statistical significance level. Results: There were 6448 deliveries and 4129 gynaecological admissions. The mean age of the patients was 29 ± 3 years. Most (76.3%) of the participants (61) were multiparous, whereas only (2) 2.5% of the participants were grand-multiparous. The EP prevalence rate was 1.2% (80 out of 6448), and it constituted 1.9% (80 out of 4129) of all gynaecological  admissions. All the patients presented with ruptured EP. The main presentation of EP among the participants was abdominal pain (69, [86.3%]), while the most presenting risk factor was a history of induced abortion (52, [65%]). Conclusion: We concluded that ectopic gestation remains a major gynaecological emergency in our environment. Most of our patients had ruptured EP, which could negatively impact our society, which places a high premium on childbearing. Keywords: Ectopic pregnancy, evaluation, gynaecological emergencies, ruptured, unrupture

Evidence for decreasing sperm count in African population from 1965 to 2015

Purpose: This meta-analysis, following our previous reports those documented an overall 57% diminution in mean sperm concentration around the globe over past 35 years and 32.5% decline in past 50 years in European population, attempts to report the declining trend of sperm concentrations in African population between 1965 and 2015. Methods: In the course of retrieval of data following MOOSE guidelines and PRISMA checklist, we found a total of fourteen studies that have been conducted during that period on altering sperm concentration in the African male. Results: Following analysis of the data, a time-dependent decline of sperm concentration (r = -0.597, p = 0.02) and an overall 72.6% decrease in mean sperm concentration was noted in the past 50 years. The major matter of concern is the present mean concentration (20.38 7106/ml) is very near to WHO cut-off value of 2010 of 15 7106/ml. Several epidemic diseases, genital tract infection, pesticides and heavy metal toxicity, regular consumption of tobacco and alcohol are reported as predominant causative factors. Conclusion: This comprehensive, evidence-based meta-analysis and systematic review concisely presents the evidence of decreased sperm concentration in the African male over past 50 years with possible causative factors to serve the scientific research zone related to male reproductive health

Successful quadruplet surrogate pregnancy after turbulent medical disorders in first trimester

Quadruplet surrogate pregnancy is a rare pregnancy but, has become common due to assisted reproductive technology (ART). Its management is a big challenge to obstetricians and co-clinicians worldwide. This was a pregnancy managed at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria in a 33 year old hypertensive surrogate mother with turbulent first trimester medical disorders that called for termination of the pregnancy by other co-managing clinicians. However, the pregnancy became stable in late 2nd trimester with emergency caesarean section at 33 weeks following preterm premature rupture of membranes (PPROM). Its management was a big challenge that necessitated multidisciplinary approach with successful outcome of four healthy live babies (three males and one female) and the controversial practice of surrogac

Association between serum chlamydial antibody levels and tubal infertility in tertiary health facility in South-East Nigeria: a case-control study

Objectives: This study evaluates the association between genital Chlamydial infection and tubal factor infertility in a tertiary health facility in South-East Nigeria.Design: This was a case-control analytical study.Setting: Gynaecology Clinic and Maternity Unit of the Department of Obstetrics and Gynaecology of the Federal Medical Centre (FMC), Owerri, Imo State, Nigeria.Participants: Ninety-six (96) women with confirmed tubal factor infertility served as the cases, and 96 women with normal intra-uterine pregnancy matched in age served as the control.Data Collection/Intervention: A structured questionnaire was used to extract information on the sociodemographic data and the sexual history of the participants. About 2mls of blood was collected, the blood was allowed to clot, and the sera were used for the test.Statistical analysis/Main outcome measure: Pearson Chi-square, Fisher’s exact test, likelihood ratio and multivariate logistic regression were used to determine risk associations and identify factors independently related to tubal factor infertility. P-value < 0.05 was considered significant.Results: The sociodemographic characteristics of both cases and control did not differ (P = 0.975). The Chlamydial antibody seropositivity was significantly higher in the cases than the control 78(81.2%) versus 13(13.5%) respectively {(P < 0.001; OR (95% CI) = 27.7(12.7-60.2)}. Only lower abdominal pain {(P = 0.011); OR (95% CI) = 4.3(1.4-13.3)}; was independently associated with tubal factor infertility.Conclusion: Tubal factor infertility is strongly associated with chlamydial IgG antibodies, and a history of lower abdominal pain significantly predicted tubal factor infertility

Barriers and facilitators of access to maternal, newborn and child health services during the first wave of COVID-19 pandemic in Nigeria: Findings from a qualitative study

Background: COVID-19 pandemic may have affected the utilization of maternal and newborn child health services in Nigeria but the extent, directions, contextual factors at all the levels of healthcare service delivery in Nigeria is yet to be fully explored. The objective of the study was to explore the barriers and facilitators of access to MNCH services during the first wave of COVID-19 pandemic in Nigeria. Methods: A qualitative study was conducted among different stakeholder groups in 18 public health facilities in Nigeria between May and July,2020. In-depth interviews were conducted among 54 study participants (service users, service providers and policymakers) selected from across the three tiers of public health service delivery system in Nigeria (primary health centers, secondary health centers and tertiary health centers). Coding of the qualitative data and identification of themes from the transcripts were carried out and thematic approach was used for data analyses. Results: Barriers to accessing MNCH services during the first wave of COVID-19-pandemic in Nigeria include fear of contracting COVID-19 infection at health facilities, transportation difficulties, stigmatization of sick persons, lack of personal protective equipment (PPE) /medical commodities, long waiting times at hospitals, shortage of manpower, lack of preparedness by health workers, and prioritization of essential services. Enablers to access include the COVID-19 non-pharmacological measures instituted at the health facilities, community sensitization on healthcare access during the pandemic, and alternative strategies for administering immunization service at the clinics. Conclusion: Access to MNCH services were negatively affected by lockdown during the first wave of COVID-19 pandemic in Nigeria particularly due to challenges resulting from restrictions in movements which affected patients/healthcare providers ability to reach the hospitals as well as patients’ ability to pay for health care services. Additionally, there was fear of contracting COVID-19 infection at health facilities and the health systems inability to provide enabling conditions for sustained utilization of MNCH services. There is need for government to institute alternative measures to halt the spread of diseases instead of lockdowns so as to ensure unhindered access to MNCH services during future pandemics. This may include immediate sensitization of the general public on modes of transmission of any emergent infectious disease as well as training of health workers on emergency preparedness and alternative service delivery models

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways