Prevention of cervical cancer among female undergraduates in two universities in south-western Nigeria

Background: Cervical cancer (CC) is the leading cause of death from cancer among women in developing countries.Objectives: The study assessed the effects of an educational package on the knowledge of female undergraduates (FUs) on CC and its prevention using the Pap smear.Study Design: A quasi experimental design was adopted. Two universities in South west Nigeria was used. Forty subjects who were sexually active were recruited from each university. Instruments used were an educational package and a semi structured questionnaire. The experimental subjects were given access to free Pap smear as a preventive measure. Data collected were analyzed using descriptive statistics and test. Ethical clearance was taken from the institutions while informed consent was taken from each subject.Results: The results showed that 10% of experimental and 17.5% of the control subjects had good knowledge of CC and its prevention at pre-intervention. At post intervention, 92.5% of the experimental and 35% of the control group had good knowledge. During the intervention, 42.5% of experimental had Pap's Smear. Of these subjects that had Pap smear, 47% had abnormal results that required cytology and further investigation. At p= 0.001, there was a significant difference in the mean scores of both groups.Conclusion: The introduction of a health education package and provision of Pap smear significantly improved the knowledge of FUs on CC and their uptake of Pap smear. It is recommended that health education on CC and prevention using HPV vaccines and Pap smear be given to University students.Keywords: Cervical Cancer, Educational Package, Pap Smear, Female UndergraduatesTrop J Obstet Gynaecol, 30 (1), April 201

Factors influencing contraceptives use among grandmultipara in Ile-Ife, Nigeria

Objective: To determine modifiable factors that influence contraceptive usage among grandmutiparas in a South-Western Nigerian setting.Methodology: A prospective survey was done among antenatal attendees in OAUTHC from January toDecember 2006. Using interviewer administered semi-structured questionnaire data were collected from all  grandmultiparous attendees on sociodemographic characteristics, contraceptive awareness and usage, contraceptive intentions and the role of men on contraceptives usage. Data were analysed with SPSS 11.0 and result presented in descriptive statistics.Results: The prevalence of grandmultiparity was 9.04% in the studied population, and their mean age was 36.73 + 4.7years: Eighty-one percent attended secondary school, and 65% were monogamous. Despite high level of awareness (51.6-100%) contraceptive usage was low (5.9 to 40.8%). About 90% agreed that family planning improve quality of family life. While 80% had no intention for further childbearing only 36% intended to use BTL. Sex preference was the only motivation for further childbearing in all (100%) of them.Conclusion: High literacy rate in this group did not impart positively in reducing the unmet need. Increased awareness on permanent  contraception and the role of men need to be promoted. Health education that will break the negative strongholds of cultural factors has to be introduced gradually at the primary school levels.Keywords: Contraceptive usage, Grandmultiparity, Cultural factors

Outcomes and challenges in the management of gestational trophoblastic disease in a tertiary institution in Nigeria

Context: Gestational Trophoblastic Diseases are a spectrum of interrelated diseases disorders that arise from abnormal pregnancy and are characterized by excessive elevation of Human Chorionic Gonadotrophins. They include both benign and malignant forms; hydatidiform mole, Invasive mole, Placental Site Trophoblastic (PSTT) tumour and Choriocarcinoma.Objective: The objective of this study was to present the outcomes and challenges encountered in the management of GTDs in a tertiary centre in South-western part of Nigeria.Study Design, Setting and Subjects: This was a retrospective study of the cases of gestational trophoblastic disease managed at Obafemi Awolowo University Teaching hospitals complex, Ile Ife between 2009 and 2013. Data were retrieved from the case records and telephone calls were put across the patients to enquire about the state of health of the patients. Data was analysed using SPSS version 20.Main Outcome Measures: The main outcome measures were the incidence of GTDs, outcomes and challenges encountered in the management of patients with gestational trophoblastic disease.Results: A total of 27 women were managed for GTDs; 22 had hydatidiform moles and 5 were managed for choriocarcinoma. The mean age of the patients was 31.9 years SD 6.94, mean parity 2 SD 1.53; mean duration of amenorrhoea was 15.7 weeks SD 4.92. The most common presenting symptom was vaginal bleeding in 81.5% of cases. Non-adherence to prescribed treatment was high as over half of the patients with molar pregnancy was lost to follow up after molar evacuation. Mortality was also high among patients with GTDs as 60% of the patients with choriocarcinoma died during treatment

Maternal death and obstetric care audits in Nigeria: A systematic review of barriers and enabling factors in the provision of emergency care.

Acknowledgements We would like to thank Yutaka Osakabe for co-ordinating the retrieval of full text articles. The John D. and Catherine T. MacArthur Foundation supported this study, grant number 12-100074-000-INPPeer reviewedPublisher PD

Cross sectional comparative study between women admitted for ruptured ectopic pregnancy and those who presented at the antenatal booking clinic at a secondary hospital in southwest Nigeria

Background: Ectopic pregnancy is a major gynaecological emergency; it is a major contributor to the high maternal mortality in Nigeria. Most patients in developing countries often present with rupture due to delay in seeking medical intervention. With ruptured ectopic pregnancy, treatment is salpingectomy leading to reduced fertility. In most parts of the world, especially, in developing countries the incidence of ectopic pregnancy has increased in the last three decadesObjective: To compare the socio-demographic, sexual and reproductive factors among patients managed for ectopic pregnancy and pregnant women attending the ante-natal care in a secondary care centre.Method: In this comparative study, 102 patients who presented with ruptured ectopic pregnancy over a period of twelve months to the State Specialist Hospital, Akure were compared with 100 randomly selected pregnant women in the second trimester (control) from the booking clinic of the same hospital.Results: There were 2376 live births and 1058 gynaecological ward admissions during the period out of which 102 were ectopic pregnancies. The incidence of ruptured ectopic pregnancy in this study was 4.3% or 4293 per 100,000 live births and it accounted for 9.6% of all gynaecological admissions. Patients in both arms were similar in age, marital status and parity but different in socio-economic status. More women in the control group belonged to the high socio-economic class. The odds ratio of developing ectopic pregnancywas highest for history of previous use of IUCD (7.7955 95% CI 1.7233 to 35.2640) and lowest for previous pelvic surgery (0.4160 95% CI 0.2159 to 0.8016).Conclusion: Ectopic pregnancy has a high incidence in developing countries and is a major indication for admission to the gynaecological ward. Major risk factor for ectopic pregnancy in this study was previous use of IUCD OR 7.7955 95% CI 1.72 to 35.26Keywords: Ruptured ectopic pregnancy, booked patients, risk factors, odd ratio

Post partum haemorrhage in a teaching hospital in Nigeria: a 5-year experience

Objectives: The aim was to determine the incidence, causes and the maternal mortality associated with postpartum haemorrhage in a tertiary centre in Nigeria. Methods: Case records of all patients that had postpartum haemorrhage after vaginal delivery at Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife unit over a 5-year period (January 1st, 2002 to December 31st, 2006) were reviewed and analysed. Post-partum blood loss was calculated by estimating blood loses in graduated containers and in bed lines and gauze packs. Results: 112 women had postpartum haemorrhage during the period under review. 76(67.86%) had primary postpartum haemorrhage and 36(32.14%) had secondary postpartum haemorrhage. The commonest cause of post partum haemorrhage was retained products of conception due mismanagement of the third stage of labour, this occurred in 88 women (78.57%) of cases. Other causes were uterine atony 12(10.71%), genital tract laceration 9(8.04%), disseminated intravascular coagulopathy 1(0.8%) puerperal sepsis 1(0.8%) and broken down episiotomy, 1(0.8%). The maternal mortality during the period was 90 out of which 6 were due to postpartum haemorrhage. Conclusion: Retained products of conception resulting from mismanagement of the third stage of labour is the most common cause of post partum haemorrhage in our centre

Criteria Based Audit of the Management of Severe Preeclampsia/ Eclampsia in a Nigerian Teaching Hospital

Background: This study discusses the usage of criteria –based audit in a Nigerian teaching hospital to evaluate the quality of care among patients with severe pre-eclampsia/eclampsia (SPE-E) against set standards and proffers possible interventions in order to improve the quality of care.Methods: The study was a prospective, descriptive hospital based study carried out from 1st of March to 31st of December, 2012. We conducted an 18 criterion-based audit on 52 consecutive cases of severe preeclampsia/eclampsia during the study period at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria.Results: There were 34 cases of severe pre-eclampsia and 18 eclamptic patients. The case fatality rate for SPE-E was 5.8 % and 13.5 % perinatal deaths among 59 infants delivered (multiple pregnancies inclusive). From the pre-determined standard of care based on 18 criteria, the performance score ranged from 17.3 to 100% (average 69.1%). Standard of care was optimal (100%) in taking detailed history and documentation, administering magnesium sulfate, initiating drug treatment for severe hypertension, respiratory rate monitoring and steroid treatment for fetal lung maturity and very sub-optimal for various laboratory investigations and initial consultant obstetrician input in the management of patients.Conclusion: For improvements in maternal and perinatal outcomes for patients with SPE-E, there should be strengthening of hospital facilities and avoidance of Phase 3 treatment delays in carrying out the comprehensive emergency obstetric and neonatal care needed. Hospital leaders should also be trained in hospital management for qualitative care.Keywords: Severe pre-eclampsia, eclampsia, criteria-based audit